Learning Curve of Single-Port Laparoscopic Choledochal Cyst Excision and Roux-En-Y Hepaticojejunostomy in Children: A Single Surgeon's Experience.

PURPOSE: To investigate the trajectory of the learning curve of single-port laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy (SPCH), and to assess the determinants influencing the duration of the surgical procedure.

METHODS

A prospective observative cohort was established from March 15, 2020 to May 1, 2025 to analyze the learning curve of SPCH, utilizing the cumulative sum method (CUSUM). Demographic data, imaging information, surgical details, postoperative imaging findings, and other follow-up information were recorded; multiple linear regression analysis was performed to identify factors affecting surgical outcomes.

RESULTS

A total of 70 surgeries were completed. CUSUM analysis revealed that a cumulative 29 cases of SPCH were needed to complete the learning curve. Multiple linear regression indicated that longer operative duration was significantly related to more blood loss (β: 2.690, SE: 0.6473, 95% CI: 1.393 to 3.987, p = 0.0001) and the greater diameter of the cyst (β: 12.95, SE: 3.621, 95% CI: 5.692 to 20.20, p = 0.0007).

CONCLUSION

For a surgeon experienced in conventional laparoscopic choledochal cyst excision, 29 cases were required to complete the learning curve for SPCH. Repeated hemostasis and the dissection of larger cysts can significantly prolong operative duration.