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Robotic surgery in Hirschsprung disease: a unicentric experience on 31 procedures

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Abstract

Robotic surgery has been increasingly applied to Hirschsprung patients with encouraging results. We report the results of a 5 year unicentric experience. All consecutive HSCR patients older than 12 months who underwent a surgical procedure with robotic approach between September 2017 and August 2022 were prospectively included. We collected data regarding demographics, extent of aganglionosis, associated anomalies, indications to surgery, and a number of perioperative data such as surgical details, intraoperative and perioperative complications, length of surgery, length of hospital stay, and functional outcome. A total of 28 patients underwent 31 robotic procedures during the study period. Median age at surgery was 82 months. Eleven primary Totally Robotic Soave Pull-Through, 12 redoes, 5 innervative mapping, 2 redundant rectal pouch excision, and 1 Miles’ procedures have been performed. Median console time was 145 min. No conversion to either laparoscopy nor to laparotomy was required. Median length of hospital stay was 6 days. Two patients experienced complications requiring reiterative surgery. One patient experienced mild postoperative enterocolitis. Normal continence was achieved by 70% of patients after a median of 16 months postoperatively (80% for primary pull-throughs, 55% for redoes). To conclude, robotic surgery for older HSCR patients proved to be feasible, safe, and effective. Patients with complex surgical requirements seem to benefit most from this promising approach. Provided the economic burden is addressed and solved, robotic surgery will represent an excellent alternative for the surgical treatment of HSCR patients.

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The authors have not disclosed any funding.

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Authors and Affiliations

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

    Giulia Mottadelli, Marta Erculiani, Tiziana Milanese, Vincenza Barbetta & Alessio Pini Prato

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

    Sara Casella

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

    Maria Pia Dusio

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

    Enrico Felici

  5. Radiology Unit, The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy

    James Bakeine & Augusta Tentori

  6. Umberto Bosio Center for Digestive Diseases, The Children Hospital, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Spalto Marengo, 46, 15121, Alessandria, Italy

    Giulia Mottadelli, Marta Erculiani, Sara Casella, Maria Pia Dusio, Enrico Felici, Tiziana Milanese, Vincenza Barbetta, James Bakeine, Augusta Tentori & Alessio Pini Prato

Authors
  1. Giulia Mottadelli
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  2. Marta Erculiani
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  3. Sara Casella
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  4. Maria Pia Dusio
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  5. Enrico Felici
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  6. Tiziana Milanese
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  7. Vincenza Barbetta
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  8. James Bakeine
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  9. Augusta Tentori
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  10. Alessio Pini Prato
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Contributions

GM, ME, EF, and MPD: drafted the paper. SC: revised all histology and confirmed the diagnosis and possible need for redoing due to innervative issues. TM and VB: participated in enrolling the patients. JB and AT: performed all preoperative radiological investigations required to determine the need for surgery. APP: conceived the study and performed all surgical procedures. All authors revised and approved the final version of the paper.

Corresponding author

Correspondence to Alessio Pini Prato.

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Mottadelli, G., Erculiani, M., Casella, S. et al. Robotic surgery in Hirschsprung disease: a unicentric experience on 31 procedures. J Robotic Surg 17, 897–904 (2023). https://doi.org/10.1007/s11701-022-01488-5

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  • DOI: https://doi.org/10.1007/s11701-022-01488-5

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