The efficacy and safety of robotic, laparoscopic, and open surgery for pediatric choledochal cysts: a systematic review and network meta-analysis
Bibliographic record
Abstract
Background: Pediatric choledochal cysts (CCs) are typically managed via surgical treatment, and a growing number of pediatric patients with CC are undergoing robotic surgery. However, whether it offers superior safety and efficacy compared to open surgery and laparoscopic surgery remains unclear. The primary aim of this study was to compare the efficacy and safety of three surgical approaches [open cyst excision with a Roux-en-Y hepaticojejunostomy (OP), laparoscopic cyst excision with a Roux-en-Y hepaticojejunostomy (LA), and robotic cyst excision with a Roux-en-Y hepaticojejunostomy (RO)] for CC in children. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched. Two independent reviewers assessed the studies for eligibility and quality and then extracted the relevant data. Confidence in Network Meta-Analysis (CINeMA) and the Newcastle-Ottawa Scale (NOS) were applied for assessing quality. Direct statistical analyses were carried out via Stata 14.0 (StataCorp), while a network meta-analysis was performed through use of using ADDIS 1.16.18 (GetReal Initiative, Innovative Medicines Initiative). Results: A total of 18 studies were included for analysis. OP had the significantly shortest operative time; RO had the significantly shortest hospital stay; and LA had the significantly lowest incidence of postoperative bowel obstruction. Conclusions: RO is effective and safe for the management of CC. The opportunity to convert to open surgery should not be missed due to fears of excessive bleeding or increased postoperative bile leakage.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.002 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".