Robotic surgery in anorectal malformations: Where are we? A systematic review

Robotic surgery has emerged as a promising technique in pediatric colorectal surgery, offering enhanced precision, superior ergonomics, and potentially improved outcomes compared to conventional laparoscopic and open approaches. This systematic review aimed to evaluate the current literature on robotic-assisted surgery for anorectal malformations (ARMs) in pediatric patients. A comprehensive search of PubMed, Web of Science, and the Cochrane Library was conducted for studies published between 2000 and 2025, focusing on robotic procedures in infants with ARMs. Eight studies met the inclusion criteria, reporting on a total of 39 patients (male-to-female ratio 15:0.5), with a median age at surgery of 6.9 months. The most frequent ARM types were recto-prostatic, recto-bulbar, and recto-vesical fistulas. Median operative time was 226.3 min, and median length of hospital stay was 5.5 days. No intraoperative or early postoperative complications were observed, while late complications occurred in 18% of cases. Only one study included a comparative analysis with laparoscopic-assisted PSARP, precluding meta-analysis. Robotic-assisted anorectoplasty appears to be a safe and feasible approach, particularly advantageous for nerve-sparing pelvic dissection. However, further high-quality studies are necessary to define indications, evaluate long-term functional outcomes, and compare this technique with conventional surgical approaches.