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
ARTICLE HIGHLIGHTS
Research background

Robotic-assisted surgery has been gradually introduced and applied to treat children with Hirschsprung’s disease (HSCR). However, few studies have been conducted to evaluate its safety and efficacy for HSCR treatment.

Research motivation

We aimed to investigate the medium-term outcomes of robotic-assisted surgery for treating HSCR.

Research objectives

We aimed to analyze the feasibility and efficacy of robotic-assisted proctosigmoidectomy (RAPS) with sphincter- and nerve-sparing surgery (SNS) in the treatment of HSCR.

Research methods

We conducted a multicenter prospective study of 156 infants with rectosigmoid HSCR who underwent SNS-RAPS and divided them by age into a younger group (aged ≤ 3 mo) and an older group (aged > 3 mo) for comparison. Intraoperative data, postoperative complications, and medium-term outcomes were recorded and analyzed. In patients aged ≥ 4 years, the bowel function score (BFS) was used to assess overall bowel function, and the postoperative fecal continence (POFC) score was used to evaluate SNS-related incontinence.

Research results

A total of 156 patients underwent successful SNS-RAPS, with 25 complications within 30 d and 48 post-30-d complications after surgery. For children aged ≥ 4 years, the overall BFS was 17.32 ± 2.63 and 90.91% of patients showed moderate-to-good bowel function, while the POFC score increased annually from 4 to 6 years old (4 years old: 10.95 ± 1.04, 5 years old: 11.48 ± 0.72, 6 years old: 11.94 ± 0.81). There were no significant differences between the younger and older groups in postoperative complications and POFC score.

Research conclusions

SNS-RAPS is a safe and effective alternative treatment for children of all ages with HSCR. It provides the advantage of further minimizing damage to sphincters and perirectal nerves, thus providing better continence function.

Research perspectives

Robotic-assisted surgery is beneficial for treating HSCR in infants and young children.