Zheng Zebing,Wang Weiao,Li Yanyi,et al.Comparison of Da Vinci robot-assisted versus laparoscopic-assisted modified Soave with short muscular cuff anastomosis for classical Hirschsprung’s disease[J].Journal of Clinical Pediatric Surgery,,():946-951.[doi:10.3760/cma.j.cn101785-202312050-009]
Comparison of Da Vinci robot-assisted versus laparoscopic-assisted modified Soave with short muscular cuff anastomosis for classical Hirschsprung’s disease
- Keywords:
- Femoral Head Haemodynamics; Superb Microvascular Imaging; Surgical Procedures; Operative; Child
- Abstract:
- Objective To compare the efficacy of Da Vinci robot-assisted and laparoscopic-assisted modified Soave with short muscular cuff anastomosis procedures for classical Hirschsprung disease (HSCR). Methods From January 2021 to December 2023, 60 HSCR children undergoing operations were retrospectively reviewed.According to operative techniques, they were assigned into two groups of robot (n=25) and laparoscopy (n=35).Operative age, body weight, operative duration, anal dissection time, intraoperative volume of blood loss, hospitalization stay length and hospitalization expense were recorded.Incidence of postoperative enterocolitis and anastomotic complications (anastomotic obstruction, anastomotic leakage & rectovaginal fistula) were compared between two groups.Postoperative defecation control status was tracked through defecation scoring system. Results Between robot and laparoscopic groups, dissection duration (20.2±3.3 vs.33.1±5.6 min), intraoperative volume of blood loss (11.0±6.0 vs.16.9±13.2 ml), hospitalization expense [(46±3) vs.(38±6) thousand yuan)], incidence of anastomotic complications [(0%, 0/25) vs.(17.1%, 6/35)], defecation frequency [(2.4±0.8) vs.(3.4±1.2)], soiling frequency [(0.72±0.73) vs.(1.4±0.9)] and postoperative defecation function score [(7.7±0.9) vs.(6.8±0.9)] .The differences were statistically significant (P<0.05).However, operative duration, hospitalization stay length and incidence of enterocolitis were not statistically significant (P>0.05). Conclusions As compared with laparoscopic-assisted approach, Da Vinci robot-assisted modified Soave with short muscular cuff anastomosis can shorten operative duration of anal dissection, lower the incidence of anastomotic complications and improve defecation function in HSCR children.
References:
[1] Montalva L, Cheng LS, Kapur R, et al.Hirschsprung disease[J].Nat Rev Dis Primers, 2023, 9(1):54.DOI:10.1038/s41572-023-00465-y.
[2] Zheng ZB, Zhang F, Jin Z, et al.Transanal endorectal stepwise gradient muscular cuff cutting pull-through method:technique refinements and comparison with laparoscopy-assisted procedures[J].Exp Ther Med, 2018, 16(3):2144-2151.DOI:10.3892/etm.2018.6414.
[3] 杨振, 黄格元.机器人在小儿外科手术中的应用及争议[J].临床小儿外科杂志, 2016, 15(4):317-321.DOI:10.3969/j.issn.1671-6353.2016.04.002. Yang Z, Huang GY.Applications and controversies of robots in pediatric surgery[J].DOI:10.3969/j.issn.1671-6353.2016.04.002.
[4] Hebra A, Smith VA, Lesher AP.Robotic Swenson pull-through for Hirschsprung’s disease in infants[J].Am Surg, 2011, 77(7):937-941.
[5] Zhang MX, Zhang X, Chang XP, et al.Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease:a multicenter prospective study[J].World J Gastroenterol, 2023, 29(23):3715-3732.DOI:10.3748/wjg.v29.i23.3715.
[6] 唐小捷, 吴杨, 向波.腹腔镜辅助下改良Soave短肌鞘术式治疗儿童常见型先天性巨结肠症的临床研究[J].中华小儿外科杂志, 2018, 39(6):419-422.DOI:10.3760/cma.j.issn.0253-3006.2018.06.004. Tang XJ, Wu Y, Xiang B.Clinical study of laparoscopic-assisted transanal endorectal pull-through with short muscle cuff for classic Hirschsprung’s disease[J].Chin J Pediatr Surg, 2018, 39(6):419-422.DOI:10.3760/cma.j.issn.0253-3006.2018.06.004.
[7] Miyano G, Koga H, Okawada M, et al.Rectal mucosal dissection commencing directly on the anorectal line versus commencing above the dentate line in laparoscopy-assisted transanal pull-through for Hirschsprung’s disease:prospective medium-term follow-up[J].J Pediatr Surg, 2015, 50(12):2041-2043.DOI:10.1016/j.jpedsurg.2015.08.022.
[8] 张茜, 常晓盼, 汤绍涛, 等.机器人辅助Soave样拖出术治疗小儿先天性巨结肠症的疗效研究[J].机器人外科学杂志(中英文), 2021, 2(4):255-262.DOI:10.12180/j.issn.2096-7721.2021.04.003. Zhang X, Chang XP, Tang ST, et al.Robotic Soave-like pull-through in children with Hirschsprung’s disease[J].Chin J Robot Surg, 2021, 2(4):255-262.DOI:10.12180/j.issn.2096-7721.2021.04.003.
[9] Georgeson KE, Cohen RD, Hebra A, et al.Primary laparoscopic-assisted endorectal colon pull-through for Hirschsprung’s disease:a new gold standard[J].Ann Surg, 1999, 229(5):678.DOI:10.1097/00000658-199905000-00010.
[10] Giuliani S, Betalli P, Narciso A, et al.Outcome comparison among laparoscopic Duhamel, laparotomic Duhamel, and transanal endorectal pull-through:a single-center, 18-year experience[J].J Laparoendosc Adv Surg Tech A, 2011, 21(9):859-863.DOI:10.1089/lap.2011.0107.
[11] Zheng ZB, Jin Z, Gao MJ, et al.Laparoscopic complete excision of the posterior muscular cuff:technique refinements and comparison with stepwise gradient muscular cuff cutting for Hirschsprung disease[J].Front Pediatr, 2022, 10:578843.DOI:10.3389/fped.2022.578843.
[12] Tang ST, Wang GB, Cao GQ, et al.10 years of experience with laparoscopic-assisted endorectal Soave pull-through procedure for Hirschsprung’s disease in China[J].J Laparoendosc Adv Surg Tech A, 2012, 22(3):280-284.DOI:10.1089/lap.2011.0081.
[13] 高明娟, 刘远梅, 祝代威.腹腔镜辅助下经肛门逐层梯度切除直肠肌鞘改良Soave术治疗小婴儿先天性巨结肠的疗效分析[J].临床小儿外科杂志, 2019, 18(10):839-843.DOI:10.3969/j.issn.1671-6353.2019.10.008. Gao MJ, Liu YM, Zhu DW.Laparoscopically assisted transanal gradient ablation of rectal muscle sheath for congenital Hirschsprung’s disease in infants[J].J Clin Ped Sur, 2019, 18(10):839-843.DOI:10.3969/j.issn.1671-6353.2019.10.008.
[14] Levitt MA, Hamrick MC, Eradi B, et al.Transanal, full-thickness, Swenson-like approach for Hirschsprung disease[J].J Pediatr Surg, 2013, 48(11):2289-2295.DOI:10.1016/j.jpedsurg.2013.03.002.
[15] Lewit RA, Kuruvilla KP, Fu M, et al.Current understanding of Hirschsprung-associated enterocolitis:Pathogenesis, diagnosis and treatment[J].Semin Pediatr Surg, 2022, 31(2):151162.DOI:10.1016/j.sempedsurg.2022.151162.
[16] Soh HJ, Nataraja RM, Pacilli M.Prevention and management of recurrent postoperative Hirschsprung’s disease obstructive symptoms and enterocolitis:systematic review and meta-analysis[J].J Pediatr Surg, 2018, 53(12):2423-2429.DOI:10.1016/j.jpedsurg.2018.08.024.
[17] Rentea RM, Noel-MacDonnell JR, Bucher BT, et al.Impact of botulinum toxin on Hirschsprung-associated enterocolitis after primary pull-through[J].J Surg Res, 2021, 261:95-104.DOI:10.1016/j.jss.2020.12.018.
[18] Yokota K, Uchida H, Tainaka T, et al.Single-stage laparoscopic transanal pull-through modified Swenson procedure without leaving a muscular cuff for short-and long-type Hirschsprung disease:a comparative study[J].Pediatr Surg Int, 2018, 34(10):1105-1110.DOI:10.1007/s00383-018-4318-1.
[19] Saadai P, Trappey AF, Goldstein AM, et al.Guidelines for the management of postoperative soiling in children with Hirschsprung disease[J].Pediatr Surg Int, 2019, 35(8):829-834.DOI:10.1007/s00383-019-04497-y.
Memo
收稿日期:2023-12-21。
基金项目:国家自然科学基金(82060100);贵州省基础研究项目(黔科合基础ZK-2021-361)
通讯作者:刘远梅,Email:yuanmei116@aliyun.com