Robot-assisted surgery for Hirschsprung's Disease: a systematic review and meta-analysis

Abstract

Background: Definitive treatment of Hirschsprung's disease (HD) is increasingly performed by minimal invasive surgery. Due to its potential advantages, robotic surgery has gained popularity. This study aims to critically review the evidence on the outcomes of robotic-assisted pull-through in children. Methods: A systematic literature-based search was conducted on PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library databases until December 2023. To be eligible for review, studies had to include HD pediatric patients submitted to primary robot-assisted pull-through and report at least one of the following outcomes: operative time, length of hospital stay (LOS), postoperative enterocolitis (HAEC) rate, other complications, functional outcomes and costs (PROSPERO protocol registration CRD42023493231). Risk of bias was appraised by National Institutes of Health assessment tool. Meta-analysis was conducted using R software. Results: From 71 retrieved studies, eight were included encompassing 348 patients. Median of ages ranged from 4 months to 2.5 years. Pooled mean operative time was 160.46 minutes (95% CI: 120.33-200.59), mean intraoperative blood loss 6.45 mL (95% CI: 2.95-9.94), mean LOS 7.08 days (95% CI: 5.51-8.64), HAEC rate 12% (95% CI: 9-17), incontinence rate 5% (95% CI: 3-9), soiling rate 8% (95% CI: 4-15), and constipation rate 5% (95% CI: 2-11). Median costs ranged from 9,990 to 10,332 USD. Conclusions: Robot-assisted pull-through revealed promising favorable outcomes, except for apparent high costs. However, included studies were observational with heterogeneous methodologies, thus randomized controlled trials with extended follow-up are needed to comprehensively assess the superiority of robotic surgery for the definitive treatment of HD in children.