Abstract: Objective To compare the perioperative and short-term outcomes of Da Vinci robotic-assisted surgery and traditional open surgery in the treatment of children with biliary atresia (BA).Methods A retrospective analysis was conducted on the clinical data of 46 children with biliary atresia admitted to Wuhan Children's Hospital from June 2015 to January 2025.All children underwent Kasai portoenterostom.Based on the surgical approach,they were divided into a Da Vinci robotic-assisted surgery group (Robotic-assisted Kasai portoenterostomy,RAKPE) and a traditional open surgery group (Open Kasai portoenterostomy,OKPE).The perioperative data,liver function indicators,and jaundice clearance rates at 6 months postoperatively were compared between the two groups.Results At the 6-month postoperative follow-up,the median values of total bilirubin and direct bilirubin in the RAKPE group were 22.3 (15.0,116.8)μmol/L and 11.8 (4.7,88.4)μmol/L,respectively.The OKPE groups were 34.5 (20.0,107.0)μmol/L and 15.5 (9.0,61.0)μmol/L respectively.There was a statistically significant difference between the two groups (P<0.05).The jaundice regression rate was 40.0% (8/20) in the RAKPE group.Among the 24 cases (2 lost to follow-up) in the OKPE group,7 cases had jaundice regression,with a jaundice regression rate of 29.2%.There was no statistically significant difference between the two groups (P>0.05).The postoperative hospital stay in the RAKPE group was 13.0 (11.0,15.0) days,and that in the OKPE group was 15.0 (13.0,18.0) days.There was a statistically significant difference between the two groups (P<0.01).The jaundice clearance rate (defined as serum total bilirubin ≤ 20 μmol/L) was 40.0% (8/20) in the RAKPE group and 29.2% (7/24,with 2 cases lost to follow-up) in the OKPE group,showing no statistically significant difference (P>0.05).The median postoperative hospital stay in the RAKPE group [13.0 (11.0,15.0) days] was significantly shorter than that in the OKPE group [15.0 (13.0,18.0) days] (P<0.01).Conclusion Robotic-assisted surgery can successfully achieve one-stage minimally invasive radical treatment for biliary atresia.Compared with traditional open surgery,it demonstrates advantages in terms of reducing bilirubin levels at 6 months postoperatively and shortening the length of postoperative hospital stay.The robotic surgical system is safe and feasible for complex pediatric hepatobiliary reconstructive surgery.However,the procedure is technically demanding,and widespread adoption requires further validation through multicenter studies.

Key words: biliary atresia, robotic surgical procedures, open abdomen techniques