Abstract / Summary
To compare the clinical effectiveness of transumbilical single-port laparoscopy and conventional laparoscopic surgery for congenital choledochal cysts and to analyze the corresponding learning curves. We retrospectively analyzed the clinical data of 106 children with congenital choledochal cysts treated at our hospital between August 2017 and October 2022. According to the surgical approach, patients were assigned to a transumbilical single-port laparoscopic group (single-port group, n = 50) or a conventional four-port laparoscopic group (four-port group, n = 56). Baseline characteristics, perioperative outcomes, and postoperative complications were compared between groups, and changes in surgical proficiency were assessed using cumulative sum (CUSUM) analysis. No statistically significant differences were observed between the two groups in intraoperative blood loss, time to postoperative gastrointestinal function recovery, postoperative length of stay, total hospitalization costs, or complication rates (all P > 0.05). The operative time was significantly longer in the single-port group, whereas the incision cosmetic satisfaction score was higher (both P < 0.05). Learning-curve analysis indicated that surgical proficiency stabilized after the 18th case in the single-port group and after the 20th case in the four-port group. When the single-port group reached the 38th case, the operative time was no longer significantly different from that in the four-port group. Both transumbilical single-port laparoscopy and conventional laparoscopic surgery are safe and effective for congenital choledochal cysts. After overcoming the initial learning curve, the transumbilical single-port approach not only maintains favorable cosmetic outcomes and cost-effectiveness but also achieves operative efficiency comparable to the conventional four-port approach after approximately 38 cases. These findings apply primarily to experienced teams transitioning to single-port surgery and should be applied cautiously in less experienced centers.