Robotic-assisted proctosigmoidectomy for Hirschsprung's disease: A multicenter prospective study

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Robotic surgery presents an advancement over laparoscopic techniques for minimally invasive procedures.
• Limited research exists on robotic surgery's application in treating Hirschsprung's disease (HSCR).

Purpose of the Study:

• To evaluate the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy (RAPS).
• To assess sphincter- and nerve-sparing approaches in HSCR patients undergoing RAPS.

Main Methods:

• A multicenter prospective study included 156 rectosigmoid HSCR patients (July 2015–January 2022).
• Sphincter and nerve preservation was achieved through complete rectal dissection outside the longitudinal muscle.
• Transanal Soave pull-through procedures were performed, followed by analysis of surgical outcomes and continence function.

Main Results:

• No intraoperative conversions or complications were reported.
• Good-to-moderate bowel function (90.91%) and promising postoperative fecal continence scores were observed in older children.
• No significant differences in outcomes were found based on age at surgery (≤3 months vs. >3 months).

Conclusions:

• Robotic-assisted proctosigmoidectomy (RAPS) is a safe and effective treatment for HSCR across all pediatric age groups.
• RAPS minimizes damage to sphincters and perirectal nerves, potentially improving long-term continence function.