Abstract:

Objective Robotic-assisted anorectoplasty (RAARP) has been reported for the treatment of anorectal malformation (ARM) in children; however, the number of reported cases remains limited, and a systematic evaluation is lacking. This study aims to compare the efficacy and safety of RAARP with those of conventional laparoscopically assisted anorectoplasty (LAARP) in the treatment of intermediate and high ARM, and to evaluate the suitability of RAARP for this condition. Methods Clinical data of 50 children with intermediate or high ARM treated between July 2019 and January 2024 were retrospectively analyzed. Patients were divided into RAARP group and LAARP group. Postoperative follow-up ranged from 12 to 60 months. Operative time (total duration and setup time), intraoperative blood loss, postoperative hospital stay, complications (rectal mucosal prolapse), and defecation function (Kelly score) were compared between the two groups. Statistical analysis was performed using SPSS 21.0, with t -test and chi-square test, and P<0.05 was considered statistically significant. Results The RAARP group and LAARP group consisted of 32 and 18 patients, respectively. No statistically significant differences were observed between the two groups in terms of sex distribution (30/32, 93.75% vs. 18/18, 100%, P=0.530), body weight at surgery (5.90 ± 0.98 kg vs. 6.06 ± 1.30 kg, P=0.645), total operative time (148.94 ± 28.43 min vs. 149.28 ± 43.97 min, P=0.974), postoperative hospital stay (8.27 ± 1.89 d vs. 7.84 ± 1.74 d, P=0.425), incidence of poor defecation function (Kelly score grade “poor”) (6.25% vs. 11.11%, P=0.540), and complication rate (9.38% vs. 11.11%, P=1.000). Compared with the LAARP group, the RAARP group had a younger surgical age (77.45 ± 29.77 d vs. 101.92 ±45.64 d, P=0.026), lower intraoperative blood loss (3.09 ± 1.87 mL vs. 4.83 ± 3.26 mL, P=0.020), but a longer setup time (17.91 ± 5.64 min vs. 1.83 ± 0.84 min, P<0.001). Conclusion RAARP demonstrates comparable perioperative safety and short-term efficacy to LAARP in the treatment of intermediate and high ARM, with long-term functional outcomes requiring further validation. The reduced intraoperative blood loss associated with RAARP suggests its potential advantage for delicate dissection in the narrow pelvic space, and younger infants with ARM may particularly benefit from this approach.

Key words: anorectal malformation, robotic-assisted anorectoplasty, laparoscopically assisted anorectoplasty, perioperative outcomes