Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2023; 29(23): 3715-3732
Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3715
Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease: A multicenter prospective study
Meng-Xin Zhang, Xi Zhang, Xiao-Pan Chang, Ji-Xiao Zeng, Hong-Qiang Bian, Guo-Qing Cao, Shuai Li, Shui-Qing Chi, Ying Zhou, Li-Ying Rong, Li Wan, Shao-Tao Tang
Meng-Xin Zhang, Xi Zhang, Guo-Qing Cao, Shuai Li, Shui-Qing Chi, Ying Zhou, Li-Ying Rong, Li Wan, Shao-Tao Tang, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Xiao-Pan Chang, Ji-Xiao Zeng, Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
Hong-Qiang Bian, Department of General Surgery, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430019, Hubei Province, China
Author contributions: Zhang MX, Zhang X, Chang XP, and Tang ST contributed to conceptualization and design; Zhang MX, Zhang X, Chang XP, Cao GQ, Li S, Chi SQ, Wan L, Zeng JX, and Bian HQ contributed to material preparation, data acquisition, and analysis; Zhang MX, Zhang X, and Chang XP contributed equally to this study; All authors contributed to writing-draft manuscript and writing-revision and approved to submit the final version.
Supported by the National Health and Family Planning of China, No. 201402007; and the National Natural Science Foundation of China, No. 81873848 and No. 82170528.
Institutional review board statement: This study was approved by the Ethics Committee at three centers: Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Guangzhou Women and Children’s Medical Center, Guangzhou Medical University; and Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology.
Clinical trial registration statement: The clinical trial is registered in the Chinese Clinical Trial Registry (Registration ID: ChiCTR2000035220). Details are available at https://www.chictr.org.cn/showproj.aspx?proj=41379.
Informed consent statement: All study participants, or their legal guardians, provided written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There is no additional data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shao-Tao Tang, Doctor, MD, PhD, Chief Doctor, Professor, Surgeon, Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, Hubei Province, China. tshaotao83@hust.edu.cn
Received: March 16, 2023
Peer-review started: March 16, 2023
First decision: April 21, 2023
Revised: April 29, 2023
Accepted: May 22, 2023
Article in press: May 22, 2023
Published online: June 21, 2023
Processing time: 92 Days and 0.1 Hours
Abstract
BACKGROUND

Robotic surgery is a cutting-edge minimally invasive technique that overcomes many shortcomings of laparoscopic techniques, yet few studies have evaluated the use of robotic surgery to treat Hirschsprung’s disease (HSCR).

AIM

To analyze the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy (RAPS) with sphincter- and nerve-sparing surgery in HSCR patients.

METHODS

From July 2015 to January 2022, 156 rectosigmoid HSCR patients were enrolled in this multicenter prospective study. Their sphincters and nerves were spared by dissecting the rectum completely from the pelvic cavity outside the longitudinal muscle of the rectum and then performing transanal Soave pull-through procedures. Surgical outcomes and continence function were analyzed.

RESULTS

No conversions or intraoperative complications occurred. The median age at surgery was 9.50 months, and the length of the removed bowel was 15.50 ± 5.23 cm. The total operation time, console time, and anal traction time were 155.22 ± 16.77, 58.01 ± 7.71, and 45.28 ± 8.15 min. There were 25 complications within 30 d and 48 post-30-d complications. For children aged ≥ 4 years, the bowel function score (BFS) was 17.32 ± 2.63, and 90.91% of patients showed moderate-to-good bowel function. The postoperative fecal continence (POFC) score was 10.95 ± 1.04 at 4 years of age, 11.48 ± 0.72 at 5 years of age, and 11.94 ± 0.81 at 6 years of age, showing a promising annual trend. There were no significant differences in postoperative complications, BFS, and POFC scores related to age at surgery being ≤ 3 mo or > 3 mo.

CONCLUSION

RAPS is a safe and effective alternative for treating HSCR in children of all ages; it offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better continence function.

Keywords: Robotic-assisted; Hirschsprung’s disease; Continence function; Sphincter; Nerve

Core Tip: We present the largest series of patients with Hirschsprung’s disease treated with robotic-assisted proctosigmoidectomy (RAPS). RAPS is a safe and effective alternative for treating Hirschsprung’s disease in children of all ages. It offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better fecal function.