Robot-assisted surgery in neonates with congenital intestinal malrotation

Open Ladd's procedure remains the gold standard for intestinal malrotation correction, while laparoscopic techniques have advanced significantly. However, reports on robot-assisted surgery for this condition are lacking. This study evaluates our experience with robot-assisted surgery for malrotation, focusing on its feasibility, safety, and effectiveness. We performed a retrospective analysis of patients who underwent robot-assisted surgery for intestinal malrotation at our hospital from January 2019 to December 2022. Data on surgical procedures, perioperative management, and follow-up outcomes were collected. A total of 45 patients (mean age: 11.7 days) underwent robot-assisted surgery without conversion to open procedures. All patients were symptomatic, with surgeries completed in an average of 57 min (range: 42–78). The intra-abdominal pressure (IAP) was 5.6 mmHg (range: 5–7), and the end-tidal carbon dioxide (ETCO 2 ) was 38.4 mmHg (range: 35–45). Mechanical ventilation lasted an average of 5.2 h (range: 4–9). Initial oral feeding commenced at 3.1 days (range: 2–6) post-surgery, with sufficient feeding achieved by 7.2 days (range: 5–18). The average hospital stay was 12.1 days (range: 9–27). One patient experienced prolonged hospitalization (27 days) due to abnormal intestinal motility. At an average follow-up of 11 months (range: 6–18), one (2.2 %) patient required redo surgery for obstruction, and three (6.7 %) had incision infections. The remaining 41 patients recovered without complications such as vomiting or abdominal distension. Robot-assisted surgery for intestinal malrotation is a reliable and feasible approach, yielding favorable surgical outcomes.