Severance Hospital Successfully Performs Robotic 'Kasai Procedure' on 14-Day-Old Newborn with Biliary Atresia

"World's Youngest and Lowest-Weight Case"

Severance Hospital announced on July 1 that it had successfully performed a robotic Kasai procedure on a newborn just 14 days old.

Professor Inkyung, a pediatric surgeon, performing surgery. Severance Hospital

Biliary atresia, a rare and intractable disease, occurs in approximately one out of every 10,000 newborns. In this condition, bile, which aids in fat digestion, cannot flow into the small intestine and instead accumulates in the liver. Severance Hospital performed the Kasai procedure—which directly connects the liver hilum to the small intestine in place of the blocked bile duct—on an infant weighing only 3.14 kg. According to the hospital, this is the world's youngest and lowest-weight case ever documented in the literature for a robotic Kasai procedure performed on a newborn with biliary atresia weighing less than 4 kg.

Professor Inkyung Lim of the Department of Pediatric Surgery at Severance Hospital performed the robotic Kasai procedure on baby A, who was born with biliary atresia, over the course of 5 hours and 8 minutes on June 4. The surgery was conducted so stably that there was almost no bleeding, making a transfusion unnecessary. Baby A recovered without any complications and was discharged on June 30.

During pregnancy, baby A’s mother was informed via prenatal ultrasound that the fetus had a cystic lesion in the lower part of the liver and subsequently consulted Professor Ja-Young Kwon (Department of Obstetrics and Gynecology) at the Severance Hospital High-Risk Maternal-Fetal Integrated Care Center. Professor Ho-Sun Eun from the Department of Neonatology and the pediatric surgery team joined from the pre-delivery stage to establish a treatment plan.

Immediately after birth, baby A was transferred to the neonatal intensive care unit, where an abdominal ultrasound on day two indicated a high likelihood of biliary atresia. The medical team decided to proceed with early surgical intervention.

If biliary atresia is not treated promptly, the accumulation of bile can lead to cirrhosis and liver failure. The Kasai procedure is the standard treatment, which involves removing the blocked bile duct and directly connecting the liver hilum to the small intestine so that bile can flow properly.

The surgery involved multidisciplinary participation from the Departments of Pediatric Surgery, Neonatology, Obstetrics and Gynecology, Anesthesiology and Pain Medicine, the surgical nursing team, and the Robotic Endoscopic Surgery Center. The procedure required a high level of surgical skill to separate and reconnect organs within the limited abdominal cavity of a 3-kg-range newborn.

Professor Inkyung Lim stated, "For this patient, we were able to provide treatment at a very early stage thanks to seamless collaboration from prenatal diagnosis, postnatal assessment, neonatal intensive care, and pediatric surgery. The precision of robotic surgery, combined with Severance Hospital’s multidisciplinary teamwork, enabled us to complete the procedure safely."

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