Robotic surgery for Hirschsprung disease: a systematic review and meta-analysis

The role of robotic-assisted surgery (RAS) in Hirschsprung disease (HD) remains unclear. Although RAS could facilitate rectal dissection in challenging cases, its use could be limited by working space and instrument size in infants. This review aimed to assess the current indications and limitations of RAS in management of HD. A systematic review was conducted using PubMed, Embase, and Cochrane, including studies reporting RAS for HD. Data synthesis followed PRISMA 2020 guidelines and was organized into three groups: primary pull-through in infants, pull-through in late-diagnosed cases (age > 1 year), and redo-surgeries. Outcomes included mortality, perioperative morbidity, and long-term functional results. A meta-analysis was performed, comparing outcomes for RAS and laparoscopy in infants. Since 2000, 36 studies reported on RAS for HD, among which 16 were included (n = 515). Primary pull-through in infants was reported in 8 studies (n = 390), without conversion or intraoperative complication. Five studies compared RAS to laparoscopy reporting a lower blood loss and higher costs with RAS, but no difference in operative time, postoperative complications or functional outcomes. Five studies reported late pull-through procedures (n = 91; ages 1-18). No difference in hospital stay was observed, though one study reported fewer anastomotic complications with RAS. Regarding redo-surgery (n = 34), no intraoperative complication or conversion occurred. Robotic-assisted surgery may improve pelvic dissection in selected cases of HD, particularly in older children with delayed diagnosis or requiring redo procedures. Its superiority in primary pull-through for infants remains uncertain, but it appears beneficial in complex or challenging cases.