The follow-up of the robotic-assisted Soave procedure for Hirschsprung\u2019s disease in children

Tran Anh Quynh,Le Quang Du,Tran Hung,Pham Duy Hien,Le Hoang Long,Nguyen Thi Ngoc Tran

doi:10.1007/s11701-021-01238-z

Abstract

Robotic surgery offers three-dimensional visualization and precision of movement that could be of great value to gastrointestinal surgeons. There were many previous reports on robotic technology in performing Soave colonic resection and pull-through for Hirschsprung’s disease in children. This study described the follow-up of the Robotic-assisted Soave procedure for Hirschsprung’s disease in children. Robotic-assisted endorectal pull-through was performed using three robotic arms and an additional 5-mm trocar. The ganglionic and aganglionic segments were initially identified by seromuscular biopsies. The rest of the procedure was carried out according to the Soave procedure. We left a short rectal seromuscular sleeve of 1.5–2 cm above the dentate line. From December 2014 to December 2017, 55 pediatric patients were operated on. Age ranged from 6 months to 10 years old (median = 24.5 months). The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4). The mean total operative time was 93.2 ± 35 min (ranging from 80 to 180 min). Minimal blood was lost during the surgery. During the follow-up period, 41 patients (74.6%) had 1–2 defecations per day, 12 patients (21.8%) had 3–4 defecations per day, and 2 patients (3.6%) had more than 4 defecations per day. Fecal incontinence, enterocolitis, and mild soiling occurred in three (5.4%), four (7.3%), and two pediatric patients, respectively. Robotic-assisted Soave procedure for Hirschsprung’s disease in children is a safe and effective technique. However, a skilled robotic surgical team and procedural modifications are needed.

Highlights

Hirschsprung’s disease (HD) is a common cause of intestinal obstruction in the newborn
The aganglionic segment was located in the rectum (n = 38), the sigmoid colon (n = 13), and the left colon (n = 4)
There was no conversion to laparoscopic surgery or laparotomy and no intraoperative complications, including injury of other organs

Summary

Introduction

Hirschsprung’s disease (HD) is a common cause of intestinal obstruction in the newborn. It is characterized by the absence of ganglionic cells in the distal bowel beginning at the internal sphincter and extending proximally to varying distances [1]. Since the first successful treatment was reported in 1948 [2], several pull-through techniques have been developed including the laparoscopic colon pullthrough which was performed by Soave and Duhamel [3, 4]. This procedure was introduced in 1994 for HD [5]. Rickey et al (2013) reported a robotic-assisted Soave procedure in a young adult [12], and Mattiolo et al (2017) had applied this technique for older children or adults with HD [13]

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Conclusion