Feasibility and safety of transumbilical single-incision laparoendoscopic surgery for giant choledochal cysts in infants: a single-center retrospective study

Radical resection of giant choledochal cysts (diameter ≥ 10 cm) in infants presents technical challenges, particularly when attempted with minimally invasive approaches. The primary difficulty lies in the cyst’s mass effect in the limited abdominal space. Although transumbilical laparoendoscopic single-site surgery (LESS) offers potential cosmetic and minimally invasive advantages, evidence regarding its feasibility and safety for managing these giant cysts remains limited. This single-center, retrospective study with a historical control group included infants who underwent radical excision for giant choledochal cysts between June 2016 and December 2024. The final follow-up date for the full cohort was September 30, 2025. All patients were assigned to either the LESS group (n = 9) or the open surgery cohort (n = 18), which served as the historical control. During transumbilical LESS, we relied on cyst decompression and a novel “relay suspension technique”. This combination effectively facilitated intraoperative exposure. Perioperative and follow-up outcomes were compared between the two groups. The two groups were comparable in baseline characteristics. Operative time was longer in the LESS group (median 3.4 h vs. 2.5 h; p = 0.006). However, patients benefited from reduced intraoperative blood loss (median 10.0 ml vs. 20.0 ml; p < 0.001), shorter postoperative fasting time (median 2.0 days vs. 3.0 days; p = 0.011), and shorter duration of abdominal drainage (median 0.0 days vs. 4.0 days; p = 0.001). The two groups demonstrated comparable postoperative hospital stays and complication rates. All LESS procedures were completed without conversion to open surgery. At a median follow-up of 33 months, no late complications occurred in the LESS group, and cosmetic outcomes were favorable. In this preliminary single-center retrospective study, the transumbilical LESS approach was supplemented by cyst decompression and a “relay suspension technique.” For specific infants with giant choledochal cysts, this approach appears to be a feasible and safe minimally invasive option. But this conclusion is based on procedures performed by experienced teams at specialized centers. This approach offers potential advantages in blood loss and early recovery. At a median follow-up of 33 months, cosmetic and long-term outcomes are favorable. While these findings are encouraging, they should be considered preliminary pending validation in larger, prospective studies.