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Totally robotic soave pull-through procedure for Hirschsprung’s disease: lessons learned from 11 consecutive pediatric patients

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Abstract

Introduction

Since Hirschsprung’s disease (HSCR) already proved to benefit from robotic surgery, we aimed at describing a wider series of patients with this rare disease who were operated on with a robotic approach.

Patients and methods

All consecutive HSCR patients who underwent totally robotic soave pull-through (TRSPT), between October 2015 and June 2019, have been included. Ethical Committee approval was obtained. Data regarding clinical features, technical details, complications, hospital stay, and functional outcome have been prospectively collected for each patient.

Results

Eleven patients have been included. Mean age at surgery was 29 months. Median length of surgery was 420 min. Median console time was 180 min. Six patients suffered from rectosigmoid aganglionosis, three from long HSCR (extending up to the hepatic flexure), two from total colonic aganglionosis. No major intraoperative complications occurred. Four patients (three of whom carrying a stoma) experienced minor mucosal tearing during dissection. One anastomotic stricture required dilatation under general anesthesia and two cuff strictures required cuff release (both occurring in patients who experienced intraoperative mucosal tearing). Follow-up lasted a median of 12 months. One patient experienced mild postoperative enterocolitis. Continence scored excellent-to-good in all patients who could be assessed on that regard (7 out of 11).

Conclusions

Provided a number of technical key points are respected, the outcome of TRSPT for HSCR is promising. Younger patients, particularly those carrying a stoma, proved to be technically demanding and deserve a longer learning curve. Accurate preoperative bowel preparation, correct trocar placement and patient positioning proved to be crucial aspects of treatment. To conclude, TRSPT is particularly suitable for older HSCR patients, even those requiring a redo, and represents a valid alternative to available surgical option for this delicate subgroup of HSCR patients.

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Acknowledgements

We want to thank Dr. Maurizio Mancuso who keeps and maintain the Hospital Registry of robotic surgery within the AON SS Antonio e Biagio e Cesare Arrigo for his invaluable help and contribution to our clinical and research activity.

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Authors and Affiliations

  1. Unit of Pediatric Surgery, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Alessio Pini Prato, Rossella Arnoldi, Vincenza Barbetta & Claudio Carlini

  2. Unit of Pediatric Anesthesia, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Maria Pia Dusio & Angela Cimorelli

  3. Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Enrico Felici

  4. Pathology Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Paola Barbieri

  5. Unit of Pediatric Radiology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Stefano Barbero

  6. Giannina Gaslini Institute, Genoa, Italy

    Paolo Petralia & Girolamo Mattioli

  7. “Umberto Bosio” Center for Digestive Diseases, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    Alessio Pini Prato, Rossella Arnoldi, Maria Pia Dusio, Angela Cimorelli, Vincenza Barbetta, Enrico Felici, Paola Barbieri, Stefano Barbero, Claudio Carlini, Annalisa Roveta & Antonio Maconi

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  1. Alessio Pini Prato
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  2. Rossella Arnoldi
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  3. Maria Pia Dusio
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  4. Angela Cimorelli
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  5. Vincenza Barbetta
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  7. Paola Barbieri
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  8. Stefano Barbero
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  9. Claudio Carlini
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  10. Paolo Petralia
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  11. Girolamo Mattioli
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  12. Annalisa Roveta
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  13. Antonio Maconi
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Corresponding author

Correspondence to Alessio Pini Prato.

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Conflict of interest

All authors declare that there are no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. In particular, Ethical Committee approval was obtained on June 15, 2017, ID being ASO.CHIRT.17.01, as previously stated in “Patients and Methods” section.

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Informed consent was obtained from all individual participants included in this study.

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Pini Prato, A., Arnoldi, R., Dusio, M.P. et al. Totally robotic soave pull-through procedure for Hirschsprung’s disease: lessons learned from 11 consecutive pediatric patients. Pediatr Surg Int 36, 209–218 (2020). https://doi.org/10.1007/s00383-019-04593-z

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  • DOI: https://doi.org/10.1007/s00383-019-04593-z

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