Comparison of robotic-assisted versus laparoscopic-assisted modified Soave pull-through with short muscular cuff anastomosis in infants under 3 months with classical Hirschsprung disease

To compare the clinical efficacy of robotic-assisted versus laparoscopic-assisted modified Soave pull-through with short muscular cuff anastomosis in infants under 3 months of age with classical Hirschsprung's disease (HSCR).

A retrospective analysis was conducted on 35 infants under 3 months with classical HSCR who underwent radical surgery at our hospital from January 2020 to December 2024. Among them, 19 underwent robotic-assisted surgery (robotic group), and 16 underwent laparoscopic-assisted surgery (laparoscopic group). Baseline characteristics, perioperative outcomes, postoperative complications, and defecation function were compared between the two groups.

Baseline characteristics were comparable between groups (P > 0.05). Compared with the laparoscopic group, the robotic group had significantly shorter total operative time [(142.5 ± 16.8) min vs (171.3 ± 24.6) min; P < 0.05], shorter anal dissection time [(20.8 ± 5.2) min vs (36.7 ± 9.8) min; P < 0.05], less intraoperative blood loss [(6.5 ± 2.4) ml vs (11.0 ± 5.6) ml; P < 0.05], and shorter postoperative hospital stays [(7.2 ± 1.6) d vs (8.9 ± 2.4) d; P < 0.05]. The incidence of postoperative enterocolitis was significantly lower in the robotic group [0 (0%) vs. 4 (25.0%); P < 0.05]. Regarding defecation function, the robotic group showed fewer daily soiling episodes [(0.8 ± 0.6) vs (1.6 ± 0.9); P < 0.05] and higher Kelly scores [(2.9 ± 0.3) points vs (2.4 ± 0.7) points; P < 0.05]. No significant differences were observed between the two groups in terms of anastomotic complications, need for constipation intervention, daily bowel movement frequency, or excellent rate of defecation function (P > 0.05).

In this non-randomized, retrospective comparison, robotic-assisted modified Soave pull-through with short muscular cuff anastomosis was found to be safe and feasible for infants under 3 months with classical HSCR. The robotic approach was associated with shorter operative time, reduced intraoperative blood loss, shorter hospital stays, and may be associated with improved mid-term defecation function compared with laparoscopic assistance.