ArticleJournal of robotic surgery2026
Body weight-associated procedural bottlenecks in robot-assisted surgery for congenital biliary dilatation: a step-specific operative time analysis.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Adults and heavier patients undergoing robot-assisted surgery for congenital biliary dilatation may require longer operative times. This study used step-specific video analysis to identify where additional time accumulated and which components remained relatively stable across patient size. Fifty-five patients (32 children and 23 adults) were retrospectively analyzed. Operative videos were divided into seven predefined steps and unclassified time. Step-specific durations were compared between groups. Restricted cubic spline and segmented regression analyses explored relationships between body weight and step-specific operative time. Total operative time was longer in adults than in children (509.0 vs. 386.0 min; P < 0.001). Adults required longer times for access and preparation, the Kocher maneuver, pancreatic-side bile duct dissection, Roux-en-Y limb creation and mesenteric fixation, final procedural steps, and unclassified workflow time. Hepatic duct dissection and ductoplasty and hepaticojejunostomy times were similar between groups. Pancreatic-side dissection time was longer in patients with postoperative pancreatic fistulas than in those without it (83.0 vs. 73.0 min; P = 0.039). Segmented regression yielded an exploratory breakpoint estimate of 17.8 kg (95% confidence interval, 9.6-25.9 kg). Using 18 kg as a data-derived exploratory cutoff, patients weighing ≥ 18 kg had longer access, dissection, intestinal preparation, and workflow times, without significant differences in biliary reconstruction times. Longer operative times in adults and heavier patients were concentrated in access, pancreatic-side bile duct dissection, intestinal preparation, and workflow, with no significant difference in biliary reconstruction times. The fistula association and the breakpoint are hypothesis-generating findings that require external validation.
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