Severance Hospital performs world-first robotic Kasai surgery on 14-day-old newborn

Severance Hospital announced Tuesday that it had successfully performed a robotic Kasai procedure on a 14-day-old newborn.

Biliary atresia is a rare and intractable condition affecting roughly one in every 10,000 newborns, in which bile that aids fat digestion cannot flow into the small intestine and instead accumulates in the liver. Severance Hospital performed the Kasai procedure — which bypasses the blocked bile duct by connecting the liver's portal opening directly to the small intestine — on an infant weighing just 3.14 kilograms.

The case marks the first reported instance in the medical literature of a robotic Kasai procedure performed on a patient under 4 kilograms, making the infant the youngest and lightest recipient of the surgery on record.

Professor In Kyung of the hospital's pediatric surgery department performed the robotic Kasai procedure on Baby A, a 14-day-old patient, on Friday, with the operation lasting five hours and eight minutes. The surgery was stable enough that virtually no bleeding occurred and no blood transfusion was needed. Baby A recovered without complications and was discharged Monday.

Baby A's mother had been told during a prenatal ultrasound that the fetus had a cystic lesion in the lower part of the liver. The presence of such a fluid-filled sac can indicate an abnormality in the bile duct and typically warrants further examination.

The mother immediately sought care from Professor Kwon Ja-young of the hospital's high-risk maternal-fetal integrated treatment center. Professor Eun Ho-seon of the neonatology department and the pediatric surgery team also joined the care before delivery, drawing up a treatment plan to ensure Baby A could safely undergo surgery after birth.

Immediately after birth, Baby A was transferred to the neonatal intensive care unit for detailed examination. An abdominal ultrasound on the second day of life confirmed the cystic lesion in the lower liver, and further tests led the medical team to conclude that biliary atresia was highly likely, prompting an early decision to operate.

If biliary atresia is not treated promptly, accumulating bile leads to liver damage and can progress to cirrhosis and liver failure. The Kasai procedure — which removes the blocked bile duct and connects the liver's portal opening directly to the small intestine to restore bile flow — is the standard treatment. The surgery is named after the Japanese physician who developed it.

The robotic Kasai procedure demanded a high level of surgical skill, as the infant's small body required removing and reconnecting organs within an extremely confined abdominal cavity. To meet that challenge, Severance Hospital assembled a full multidisciplinary team spanning pediatric surgery, neonatology, obstetrics and gynecology, anesthesiology and pain medicine, the surgical nursing team, and the robotic endoscopic surgery center.

The case illustrates how critical early diagnosis and swift surgical decision-making are in treating biliary atresia. After an abnormal finding on a prenatal ultrasound, multiple departments began coordinating a treatment plan before birth, and the seamless transition to detailed postnatal examination and surgery made it possible to complete treatment within two weeks of birth.

"Performing a robotic Kasai procedure on a newborn in the 3-kilogram range is an extremely demanding challenge in terms of surgical space and instrument manipulation," said Professor In, who led the operation. "But the precision of robotic surgery, combined with Severance Hospital's multidisciplinary collaboration, allowed us to complete the procedure safely."