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A Provisional Experience with Robot-Assisted Soave Procedure for Older Children with Hirschsprung Disease: Back to
Girolamo Mattioli1,2, Luca Pio1,2, Lorenzo Leonelli1,2
11 Istituto Giannina Gaslini , Genoa, Italy .
Insights
Robot-assisted surgery offers a minimally invasive option for older Hirschsprung disease patients. This approach reduces anal trauma and improves outcomes in complex cases.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Hirschsprung disease involves intestinal aganglionosis, often diagnosed in infants.
- Surgery for older patients presents challenges, including prolonged dissection and potential continence issues.
- Traditional pull-through procedures can lead to significant anal trauma in older individuals.
Purpose of the Study:
- To describe the first case series of robot-assisted Soave procedure in older Hirschsprung disease patients.
- To evaluate the feasibility and outcomes of this minimally invasive approach.
- To present a novel surgical technique for complex Hirschsprung disease cases.
Main Methods:
- Robot-assisted Soave procedure involving intraoperative seromuscular biopsies.
- Intracorporeal endorectal cranial dissection and endorectal pull-through with colo-anal anastomosis.
- Application of the technique in a series of older pediatric and adult patients.
Main Results:
- Three procedures were successfully completed without complications.
- The robot-assisted approach required limited anal dilatation and reduced trauma.
- Demonstrated feasibility of robot-assisted surgery for older Hirschsprung disease patients.
Conclusions:
- Robot-assisted Soave procedure is a feasible alternative for older patients with Hirschsprung disease.
- This minimally invasive approach may mitigate risks associated with traditional surgery.
- Further consideration of robotic surgery is warranted for this patient population.
Abstract:
Hirschsprung disease is a congenital disease characterized by intestinal aganglionosis of various extents. Most patients are younger than 1 year of age. Though, a minority of cases can be older or even adult. Older the patient the more difficult and prolonged is the endorectal dissection required for the pull-through procedure. Longer surgery leads to longer anal dilatation and trauma with subsequent higher likelihood of continence impairment. The article aims at describing the first case series of robot-assisted Soave procedure, which was adopted as an alternative minimally invasive approach to older patients with Hirschsprung disease. The technical principles are represented by intraoperative seromuscolar leveling biopsies, intracorporeal endorectal cranial dissection, and endorectal pull-through with colo-anal anastomosis. The authors report three procedures that were carried on without complication with a limited requirement for anal dilatation and trauma, given the reduced need for endorectal caudal dissection. The results demonstrate the feasibility of the proposed approach. The robotic approach should be considered as an alternative minimally invasive approach for older children or adults with Hirschsprung disease.
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