LONG TERM FOLLOW UP AFTER PEDIATRIC SINGLE SITE ROBOTIC CHOLECYSTECTOMY

Robotic single-site cholecystectomy (RSSC) was first reported in children by Jones (2015), who conducted a retrospective review demonstrating the feasibility, safety, and short learning curve associated with RSSC compared to single-incision laparoscopic cholecystectomy (SILC) in pediatric patients, which has been proven to be technically challenging [1]. Subsequently, Esposito et al. further supported these findings, showing similar safety and effectiveness of RSSC in pediatrics over a 6-year period [2]. Rothenberg et al. compared robotic-assisted cholecystectomy (RC) to laparoscopic cholecystectomy (LC) in children, highlighting no significant differences in immediate postoperative complications, opioid utilization, or hospital readmissions but identifying higher costs associated with RC [3]. Kulaylat et al. similarly reported longer operative times (98 vs 79 minutes) and higher overall costs ($15,519 vs $11,197) for robotic procedures compared to laparoscopic ones, though postoperative complications and length of stay (LOS) were comparable [4].

The primary advantages of RSSC identified in pediatric patients include superior cosmetic outcomes, reduced postoperative pain, and a shorter learning curve for surgeons compared to SILC. These benefits contribute to its growing acceptance among pediatric surgeons.

However, despite clear short-term benefits, the need for evaluating long-term outcomes in pediatric populations remains unmet. There are currently no studies reporting long-term complications or cosmetic satisfaction following RSSC in pediatric patients.

In adult populations, short-term studies comparing RSSC and multiport laparoscopic cholecystectomy (MLC) revealed comparable hospital stay, complication rates, seroma formation, and infection rates [5]. Hagen et al. demonstrated increased costs and higher reoperation rates for hernias with RSSC compared to MLC in adults [6]. Lurje et al. evaluated short-term cosmetic outcomes, confirming patient satisfaction with robotic surgery in adults, but no pediatric data was provided [7].

In pediatric patients, short-term follow-ups primarily emphasized operative safety, operative time, hospital stay, and immediate postoperative complications, generally showing equivalence between RC and LC with the exception of higher costs for RC [3,4].

Long-term outcomes in adult populations show conflicting reports. Marks et al. demonstrated high patient-reported cosmetic satisfaction scores at 8-year follow-up favoring SILC over conventional laparoscopic surgery [8]. Conversely, Christoffersen et al. found that most incisional hernias following SILC occurred within two years post-surgery, suggesting the need for continued monitoring [9]. Recent adult cohort studies reported comparable operative times and hospital stays between robotic and laparoscopic procedures, but with slightly higher costs associated with robotic surgery [10].

The current literature underscores significant gaps in the long-term follow-up of pediatric RSSC outcomes. To date, comprehensive evaluation of long-term hernia rates, cosmetic satisfaction, and patient-reported outcomes in children undergoing RSSC is lacking. This study aims to fill this gap by providing essential long-term data on RSSC outcomes, affirming its durability and superiority as an alternative to MLC.