Introduction : Choledochal cyst treatment requires complete excision of the cyst with bilio-enteric reconstruction. With the advancement in technology, robotic surgical system provides advantages over limitations of conventional laproscopic surgery. Here, we present three cases of robotic single site plus one port choledochal cyst excision.

Methods : Da Vinci single-site surgical platform (DVSSP) with one additional port was used. The additional robotic 8mm-port was placed on patient's right side, along the level of DVSSP. Choledochal cyst was dissected from the level of hepatic hilum to intrapancreatic common bile duct and distal part of cyst was ligated with hemo-loc clips. After transecting proximal part of cyst at the level of hilum, roux-en-Y hepaticojejunostomy was performed intracorporeally in a retrocolic manner. Drain was inserted at the additional port site.

Results : Patient #1 was a 54 year-old female diagnosed with Type I choledochal cyst, measuring 3.7 x 1.8cm. Total operation time was 420 minutes. Patient was discharged on POD #7. Patient #2 was a 45 year-old female diagnosed with Type I choledochal cyst, measuring 6.3 x 3.1cm. Total operation time was 485 minutes. Patient was discharged on POD #8. Postoperative pancreatitis was resolved after conservative care. Patient #3 was a 59 year-old male diagnosed with Type IVa choledochal cyst, measuring 8.7 x 6.4cm. Total operation time was 520 minutes. Patient was discharged on POD #13. Bile leakage was resolved after delayed removal of the drain.

Conclusions : Robotic single site plus one port choledochal cyst excision seems feasible and safe with better anatomic visualization and increased dexterity for bilio-enteric reconstruction.