Robot-assisted surgery for Hirschsprung disease in children: initial single-center experience

Introduction: Robotic surgery (RS) application to Hirschsprung disease (HSCR) is spreading. The aim of this study was to describe our series of children operated with RS for HSCR, focusing on surgical outcomes. Methods: Case series of 20 children operated for HSCR disease with robotic approach over a 10-year period (October 2015 to July 2025). Preoperative characteristics, intraoperative data, and postoperative outcomes were collected. A comparison with patients who underwent a laparoscopic surgery for HSCR disease was done. Results: The median age at surgery was 1.3 years (IQR 0.6-4.8), with a mean weight of 16 kg. Seven-teen patients had rectosigmoid HSCR (85%), and three had long-segment HSCR (15%). The median total operative time was 253 minutes (IQR 188-402), while the median console operative time was 50 minutes (IQR 40-95). Postoperatively, five patients developed mild anastomotic stenosis, and one required redo ileoanal anastomosis (5%). Median follow-up was 11 months (IQ range 5-12). At last follow-up, two patients complained mild constipation with soiling episodes (12%); and two had experienced episodes of HAEC (12%). Comparative analysis with laparoscopy showed no significant differences in operative outcomes. Conclusion: RS is a safe option for the management of HSCR. More multicentre studies are necessary to define clear indications.