# Rectal surgery for hirschsprung's disease in a single pediatric tertiary care center: improvement of rectal dissection following the introduction of robotic technology

## TL;DR

This paper discusses how robotic technology improved rectal surgery outcomes for Hirschsprung's disease in children.

## Contribution

A novel laparoscopic robot-assisted approach for Restorative Proctocolectomy in Hirschsprung's disease is introduced and evaluated.

## Key findings

- Robotic assistance enabled safer and more precise rectal dissection in selected Hirschsprung's disease patients.
- Eleven patients successfully underwent robot-assisted Restorative Proctocolectomy with minimal transanal dissection.
- The procedure is feasible in centers with advanced minimally invasive surgical expertise.

## Abstract

Several surgical techniques have been described in the literature for the treatment of Hirschsprung's disease (HD). This study presents our surgical experience in managing patients with HD and the evolution of rectal dissection following the introduction of robotic technology. We developed a novel laparoscopic robot-assisted approach and report our initial experience with Restorative Proctocolectomy with minimal transanal endorectal dissection in HD patients, detailing the technical aspects of this procedure.

We retrospectively reviewed data from patients with HD who underwent pull-through surgery at our Institution between January 2015 and July 2025.

Sixty-five patients with HD were included. Fifty-four patients underwent conventional procedures performed at our Center: two open Soave endorectal pull-through (ERPT), forty-four laparoscopic Soave-Georgeson ERPT, and eight Totally Robotic Soave ERPT with limited transanal endorectal dissection. Beginning in 2023, eleven patients underwent a robot-assisted Restorative Proctocolectomy with minimal transanal endorectal dissection.

The advantages of robotic technology allow for safer performance of pelvic and particularly rectal surgery. Based on our experience, we suggest that in selected patients with HD, Restorative Proctocolectomy with minimal transanal endorectal dissection can be safely performed using robotic assistance in Centers with advanced minimally invasive expertise in HD management.