Comparison of postoperative complications between robotic-assisted and laparoscopic-assisted surgery for children with hirschsprung's disease: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Zikang ¹ ,  LI Wanfu ¹ , ZHAO Chengpeng ² , WANG Haojun ¹ , XU Mengxue ¹

1. Department of Pediatric General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;
2. Nanyang Central Hospital Nanyang 473000, P. R. China;

Corresponding author：

LI Wanfu, Email: liwanfu71@163.com

Keywords：

Hirschsprung's disease; Robotic-assisted surgery; Laparoscopic-assisted surgery; Postoperative complications; Meta-analysis

DOI：

10.7507/1672-2531.202505134

Video：

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Objective To systematically review the postoperative complications between robotic-assisted surgery (RAS) and laparoscopic-assisted surgery (LAS) in children with hirschsprung's disease (HSCR). Methods The PubMed, Embase, Web of Science, Cochrane Library, CNKI, and WanFang Data databases were electronically searched to collect non-randomized controlled studies related to the objective from inception to May 10, 2025. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 7 studies involving 901 children were included. The results of meta-analysis showed that the RAS group had a lower incidence of postoperative enterocolitis than the LAS group (OR=0.64, 95%CI 0.42 to 0.98, P=0.04) and a higher rate of complication-free outcomes (OR=2.16, 95%CI 1.26 to 3.72, P<0.01). No statistically significant differences were found between the two groups in intraoperative duration, intraoperative blood loss, postoperative anastomotic complications, fecal soiling, adhesive intestinal obstruction, wound infection, incisional hernia, perianal infection, or urinary retention (P>0.05). Conclusion Current evidence shows that RAS significantly reduces the risk of postoperative enterocolitis and improves the rate of complication-free outcomes in children with HSCR but offers no advantages in intraoperative indicators or other complications. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

1.	付豪, 刘远梅. 基因敲除动物模型在先天性巨结肠研究中的应用进展. 中华小儿外科杂志, 2025, 46(1): 81-86.
2.	Best KE, Addor MC, Arriola L, et al. Hirschsprung's disease prevalence in Europe: a register based study. Birth Defects Res A Clin Mol Teratol, 2014, 100(9): 695-702.
3.	Montalva L, Cheng LS, Kapur R, et al. Hirschsprung disease. Nat Rev Dis Primers, 2023, 9(1): 54.
4.	Sandlas G, Bothara V, Takrouney M, et al. Robot assisted laparoscopic duhamel pull through. J Pediatr Surg Case Rep, 2020, 60: 101572.
5.	Kawaguchi AL, Guner YS, Sømme S, et al. Management and outcomes for long-segment Hirschsprung disease: a systematic review from the APSA outcomes and evidence based practice committee. J Pediatr Surg, 2021, 56(9): 1513-1523.
6.	Han G, Wang X, Li Z, et al. Robot-assisted boari-flap after orthotopic neobladder using the Kangduo surgical robot-01 system. Int Braz J Urol, 2026, 52(1): e20250341.
7.	López LH, Mourullo AN, Tamburini S, et al. Robot-assisted repair of rectovesical fistula after radical prostatectomy using the Hugo™ RAS system. Int Braz J Urol, 2026, 52(2): e20250405.
8.	Pi Y, Huang W, Wang H, et al. Gynecological surgery using the Kangduo robotic system. Ann Med, 2025, 57(1): 2534096.
9.	Roman H, Celhay O, Dennis T, et al. Robotic excision of deep endometriosis involving the superior gluteal nerve. J Minim Invasive Gynecol, 2025, 2025: S1553-S4650.
10.	Chang SH, Grossi EA, Yongue C, et al. Initial experience with fully robotic bilateral lung transplantation. J Thorac Cardiovasc Surg, 2025, 170(4): e87-e91.
11.	Richards HW, Kulaylat AN, Cooper JN, et al. Trends in robotic surgery utilization across tertiary children's hospitals in the United States. Surg Endosc, 2021, 35(11): 6066-6072.
12.	Mei H, Tang S. Robotic-assisted surgery in the pediatric surgeons' world: current situation and future prospectives. Front Pediatr, 2023, 11: 1120831.
13.	Hebra A, Smith VA, Lesher AP. Robotic swenson pull-through for hirschsprung’s disease in infants. American Surgeon, 2011, 77(7): 937-941.
14.	Haddaway NR, Page MJ, Pritchard CC, et al. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev, 2022, 18(2): e1230.
15.	Li W, Lin M, Hu H, et al. Surgical management of hirschsprung's disease: a comparative study between conventional laparoscopic surgery, transumbilical single-site laparoscopic surgery, and robotic surgery. Front Surg, 2022, 9: 924850.
16.	戴中超, 束姗姗, 张敏敏. 机器人辅助Soave手术对先天性巨结肠患儿血清炎症细胞因子水平及肛门功能恢复的影响. 中国妇幼保健, 2023, 38(8): 1539-1542.
17.	Huang J, Huang Z, Mei H, et al. Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions. Surg Endosc, 2023, 37(11): 8404-8420.
18.	Zhang S, Cai D, Zhang Y, et al. Comparation of robotic-assisted surgery and laparoscopic-assisted surgery in children with Hirschsprung's disease: a single-centered retrospective study. BMC Surg, 2023, 23(1): 294.
19.	郑泽兵, 王维鳌, 李严易, 等. 机器人与腹腔镜技术在改良Soave短肌鞘吻合术治疗先天性巨结肠中的应用. 临床小儿外科杂志, 2024, 23(10): 946-951.
20.	Hou J, Feng W, Zhao H, et al. Robotic-assisted Swenson procedure for Hirschsprung's disease with a median age of 35 days: a single-center retrospective study. Pediatr Surg Int, 2025, 41(1): 87.
21.	Zhang M, Zhang X, Chi S, et al. Robotic-assisted proctosigmoidectomy versus laparoscopic-assisted soave pull-through for hirschsprung disease: medium-term outcomes from a prospective multicenter study. Ann Surg, 2025, 281(4): 689-697.
22.	Jin Y, Cai D, Zhang S, et al. Robot-assisted abdominal surgery in children less than 5 months of age: retrospective cohort study. Int J Surg, 2024, 110(2): 859-863.
23.	Duhoky R, Claxton H, Piozzi GN, et al. Robotic approach to paediatric gastrointestinal diseases: a systematic review. Children (Basel), 2024, 11(3): 273.
24.	Li Y, He S, Jin Z, et al. Comparison of robot-assisted and laparoscopic-assisted modified Soave short muscle cuff anastomosis surgeries for classical Hirschsprung disease. BMC Surg, 2025, 25(1): 78.
25.	Zhang MX, Zhang X, Chang XP, et al. Robotic-assisted proctosigmoidectomy for Hirschsprung's disease: a multicenter prospective study. World J Gastroenterol, 2023, 29(23): 3715-3732.

1. 付豪, 刘远梅. 基因敲除动物模型在先天性巨结肠研究中的应用进展. 中华小儿外科杂志, 2025, 46(1): 81-86.
2. Best KE, Addor MC, Arriola L, et al. Hirschsprung's disease prevalence in Europe: a register based study. Birth Defects Res A Clin Mol Teratol, 2014, 100(9): 695-702.
3. Montalva L, Cheng LS, Kapur R, et al. Hirschsprung disease. Nat Rev Dis Primers, 2023, 9(1): 54.
4. Sandlas G, Bothara V, Takrouney M, et al. Robot assisted laparoscopic duhamel pull through. J Pediatr Surg Case Rep, 2020, 60: 101572.
5. Kawaguchi AL, Guner YS, Sømme S, et al. Management and outcomes for long-segment Hirschsprung disease: a systematic review from the APSA outcomes and evidence based practice committee. J Pediatr Surg, 2021, 56(9): 1513-1523.
6. Han G, Wang X, Li Z, et al. Robot-assisted boari-flap after orthotopic neobladder using the Kangduo surgical robot-01 system. Int Braz J Urol, 2026, 52(1): e20250341.
7. López LH, Mourullo AN, Tamburini S, et al. Robot-assisted repair of rectovesical fistula after radical prostatectomy using the Hugo™ RAS system. Int Braz J Urol, 2026, 52(2): e20250405.
8. Pi Y, Huang W, Wang H, et al. Gynecological surgery using the Kangduo robotic system. Ann Med, 2025, 57(1): 2534096.
9. Roman H, Celhay O, Dennis T, et al. Robotic excision of deep endometriosis involving the superior gluteal nerve. J Minim Invasive Gynecol, 2025, 2025: S1553-S4650.
10. Chang SH, Grossi EA, Yongue C, et al. Initial experience with fully robotic bilateral lung transplantation. J Thorac Cardiovasc Surg, 2025, 170(4): e87-e91.
11. Richards HW, Kulaylat AN, Cooper JN, et al. Trends in robotic surgery utilization across tertiary children's hospitals in the United States. Surg Endosc, 2021, 35(11): 6066-6072.
12. Mei H, Tang S. Robotic-assisted surgery in the pediatric surgeons' world: current situation and future prospectives. Front Pediatr, 2023, 11: 1120831.
13. Hebra A, Smith VA, Lesher AP. Robotic swenson pull-through for hirschsprung’s disease in infants. American Surgeon, 2011, 77(7): 937-941.
14. Haddaway NR, Page MJ, Pritchard CC, et al. PRISMA2020: an R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and open synthesis. Campbell Syst Rev, 2022, 18(2): e1230.
15. Li W, Lin M, Hu H, et al. Surgical management of hirschsprung's disease: a comparative study between conventional laparoscopic surgery, transumbilical single-site laparoscopic surgery, and robotic surgery. Front Surg, 2022, 9: 924850.
16. 戴中超, 束姗姗, 张敏敏. 机器人辅助Soave手术对先天性巨结肠患儿血清炎症细胞因子水平及肛门功能恢复的影响. 中国妇幼保健, 2023, 38(8): 1539-1542.
17. Huang J, Huang Z, Mei H, et al. Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions. Surg Endosc, 2023, 37(11): 8404-8420.
18. Zhang S, Cai D, Zhang Y, et al. Comparation of robotic-assisted surgery and laparoscopic-assisted surgery in children with Hirschsprung's disease: a single-centered retrospective study. BMC Surg, 2023, 23(1): 294.
19. 郑泽兵, 王维鳌, 李严易, 等. 机器人与腹腔镜技术在改良Soave短肌鞘吻合术治疗先天性巨结肠中的应用. 临床小儿外科杂志, 2024, 23(10): 946-951.
20. Hou J, Feng W, Zhao H, et al. Robotic-assisted Swenson procedure for Hirschsprung's disease with a median age of 35 days: a single-center retrospective study. Pediatr Surg Int, 2025, 41(1): 87.
21. Zhang M, Zhang X, Chi S, et al. Robotic-assisted proctosigmoidectomy versus laparoscopic-assisted soave pull-through for hirschsprung disease: medium-term outcomes from a prospective multicenter study. Ann Surg, 2025, 281(4): 689-697.
22. Jin Y, Cai D, Zhang S, et al. Robot-assisted abdominal surgery in children less than 5 months of age: retrospective cohort study. Int J Surg, 2024, 110(2): 859-863.
23. Duhoky R, Claxton H, Piozzi GN, et al. Robotic approach to paediatric gastrointestinal diseases: a systematic review. Children (Basel), 2024, 11(3): 273.
24. Li Y, He S, Jin Z, et al. Comparison of robot-assisted and laparoscopic-assisted modified Soave short muscle cuff anastomosis surgeries for classical Hirschsprung disease. BMC Surg, 2025, 25(1): 78.
25. Zhang MX, Zhang X, Chang XP, et al. Robotic-assisted proctosigmoidectomy for Hirschsprung's disease: a multicenter prospective study. World J Gastroenterol, 2023, 29(23): 3715-3732.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesComparison of postoperative complications between robotic-assisted and laparoscopic-assisted surgery for children with hirschsprung's disease: a meta-analysis

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