Robotic-assisted pull-through procedures for anorectal malformation: a systematic review
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Read the article on link.springer.com ↗Article · Jul 2024 · 1 min read
In brief
In brief
This systematic review evaluates robotic-assisted pull-through procedures for anorectal malformation in 33 pediatric cases, finding the approach feasible and safe with advantages in visualization and precision. Key challenges include prolonged operative time (mean 229 minutes) and cost, though outcomes were comparable to laparoscopic techniques with low complication rates.
- Robotic-assisted anorectoplasty (RAARP) is feasible and safe for anorectal malformations in infants as young as 3 months in experienced hands.
- Robotic magnification and endo-wrist technology enable precise fistula dissection and ligation, following the same principles as laparoscopic repair.
- Mean operative time is 228.7 minutes with 7-day hospital stay; prolonged duration and cost remain key limitations to address.
- Complications include pelvic abscess, epididymo-orchitis, and stricture; most cases reported are in males from US and Saudi Arabia centers.
- Centralization to high-volume centers and enhanced surgeon training can mitigate cost concerns and reduce operative time for RAARP.
Written by the GCMD Library team from the article.
Abstract
Aim
To study the published literature on robotic-assisted pull-through procedures for anorectal malformation.
Method
A PubMed search was done on 10th April 2024, with the words “robotic AND Anorectal malformation”. The articles were screened for relevance and the data were compiled on the safety, feasibility, technical details, and limitations of robotic-assisted procedures in children for anorectal malformation.
Results
The search robotic and anorectal malformation gave ten articles. Two were excluded as they were not relevant. Two articles were added from cross-reference. Ten publications on robotic-assisted procedures for anorectal malformation were studied, describing procedures in thirty-three cases. The youngest child operated was 3 months old. All except one case were done in males. Most articles were from the US and the Kingdom of Saudi Arabia (KSA). The principles involved in robotic-assisted anorectoplasty (RAARP) were the same as that of laparoscopic procedures. Complications reported included pelvic abscess, epididymo-orchitis, and stricture of pelvic tunnel or conversion to open. The magnification and endo-wrist technology of robotics facilitated the sharp dissection and ligation at origin of fistula. The mean operating time was 228.7 min (docking and console time), shortest being 86 min and mean hospital stay was 7 days. The number of ports used varied from 3 to 4 with 8.5 mm being the most commonly used umbilical port and 8 mm as working ports, although in one article, a 12 mm port was used for telescope. The prolonged operating time and cost are the two factors to be addressed in RAARP.
Conclusion
Robotic surgery is feasible in infants with ARM and safe in expert hands. Robotics is a very effective tool with its better ergonomics, tremor filtration, 3D magnification, and dexterity. Increasing awareness and referral to high-volume centers can tide over the cost factor, and good training of the surgeons can reduce the operative time.