Robot-assisted vs. laparoscopic-assisted surgery for choledochal cyst in children: a systematic review and meta-analysis

Objective Comprehensive analyses specifically comparing robot-assisted surgery(RS) and laparoscopic surgery(LS) for choledochal cyst(CC) in children remained scarce. This study aimed to evaluate the safety and efficacy of RS vs. LS for pediatric CC. Methods A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted to identify studies published up to December 31, 2025, that compared laparoscopic and robot-assisted surgery for CC in children. Meta-analysis was performed using Stata 18. Results A total of 19 retrospective studies were included. Meta-analysis results demonstrated that the RS group had significantly lower incidences of postoperative biliary stones (OR = 0.10, 95% CI: 0.01–0.89), bile leakage (OR = 0.28, 95% CI: 0.11–0.70), anastomotic stricture (OR = 0.27, 95% CI: 0.12–0.65), and overall complications (OR = 0.26, 95% CI: 0.13–0.51) compared to the LS group. Total operative time was longer in the RS group (SMD = 1.02; 95% CI: 0.30–1.74), whereas intraoperative blood loss was significantly lower (SMD = −1.22; 95% CI: −2.19 to −0.24). Additionally, the RS group exhibited shorter hepaticojejunostomy time (SMD = −1.43; 95% CI: −2.30 to −0.56), drainage tube indwelling time (SMD = −0.74; 95% CI: −1.01 to −0.47), postoperative fasting time (SMD = −0.80; 95% CI: −1.11 to −0.50), and hospital stay (SMD = −1.16; 95% CI: −2.08 to −0.23). No significant differences were observed in other outcomes, including postoperative cholangitis (OR = 0.59, 95% CI: 0.22–1.57), residual cyst (OR = 0.22, 95% CI: 0.02–1.94), incision infection (OR = 0.17, 95% CI: 0.02–1.41), intestinal obstruction (OR = 0.97, 95% CI: 0.40–2.33), pancreatitis (OR = 0.74, 95% CI: 0.08–6.47), pancreatic leakage (OR = 0.43, 95% CI: 0.10–1.92), and conversion to open surgery (OR = 0.79, 95% CI: 0.36–1.75). Furthermore, no statistically significant difference was found in cyst excision time between the two groups (SMD = −1.77; 95% CI: −3.91 to −0.77). Conclusion In the treatment of pediatric CC, RS offered potential advantages over LS in terms of reducing postoperative biliary-related complications, decreasing intraoperative blood loss, accelerating postoperative gastrointestinal function recovery, and shortening hospital stay. Although RS required longer operative time, this limitation might be mitigated with accumulated surgical experience and technological advancements. However, current evidence is primarily derived from retrospective studies conducted in Asian countries and lacked long-term follow-up data. Well-designed multicenter prospective studies or randomized controlled trials were urgently needed to provide higher-level evidence and further validate our findings.