Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease: A multicenter prospective study

Figure 1 Flowchart of patient selection.

Figure 2 Trocar site in robotic-assisted proctosigmoidectomy. There are three trocar ports, including a straight-cut umbilical trocar and two 8 mm working trocars located 5 cm from the umbilical trocar on either side.

Figure 3 Diagram of pelvic dissection planes and intraoperative images of pelvic dissection. A: Pelvic dissection plane of robotic-assisted proctosigmoidectomy is under the serosa of the rectum or proper rectal fascia extended serous layer below the peritoneal reflection; B: Pelvic dissection under robotic endoscopy; C: Pelvic dissection plane of conventional laparoscopic Soave surgery is performed tightly around the rectal wall; D: Pelvic dissection under laparoscopy.

Figure 4 The pelvic depth in robotic vision before and after pulling the rectum cranially; the depth becomes shallower after pulling. A: Before pulling; B: After pulling.

Figure 5 Comparison of two minimally invasive approaches and dissection length measurement of robotic-assisted proctosigmoidectomy. A: The transanal Soave anastomosis procedure is performed by making a circular incision 0.5-1 cm from the dentate line and dividing the mucosa upward by 0.2-0.4 cm; B: The length of pelvic dissection was 5.5 cm and the length of transanal dissection was 0.3 cm of robotic-assisted proctosigmoidectomy; C: The length of endorectal dissection and transanal dissection in the laparoscopic approach; D: The length of endorectal dissection and transanal dissection in the robotic approach.

Figure 6 Short- to medium-term outcomes of robotic-assisted proctosigmoidectomy. A: Occurrence of normal stool frequency at 1-6 years after surgery; B: Occurrence of enterocolitis at 1-6 years after surgery; C: Annual postoperative fecal continence score analysis among patients aged 4 years or more.