title: Robotic-assisted anorectal pull-through for anorectal malformations.
abstract: OBJECTIVE
  Many reports have addressed the feasibility and safety of using robotic surgery in children. To our knowledge, no published report has described the use of a surgical robot in the repair of anorectal malformations (ARMs).
  
  
  METHODS
  Included children underwent robotic-assisted repair of ARMs with rectourethral fistula between April 2006 and March 2010 at King Khalid University Hospital, Riyadh, Saudi Arabia, using the da Vinci Surgical System. Their medical records were reviewed with respect to demographic data, associated anomalies, techniques and operative procedures, complications, outcomes, and follow-up.
  
  
  RESULTS
  Five male infants (mean age, 6.6 months) underwent robotic-assisted repair of ARMs with rectourethral fistula using the Georgeson technique. The fistulae were divided and ligated in 4 patients and was left open in 1. All procedures were successfully completed without conversion to an open technique. One patient developed left-sided epididymo-orchitis postoperatively. All the patients had their colostomy closed. The follow-up ranged from 6 to 36 months. Fecal continence was difficult to assess in 2 patients. Two patients have voluntary bowel movements without soiling. One infant has fecal soiling and is on a laxative/enema for constipation.
  
  
  CONCLUSIONS
  Robotically assisted repair of ARMs with rectourethral fistula is feasible and safe. It offers a good alternative to the criterion standard, posterior sagittal anorectoplasty (PSARP), for repair of ARMs with rectourethral fistula. More patients and a longer follow-up period are needed for further evaluation of this novel approach.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, King Khalid University Hospital and College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia. abasssam@ksu.edu.sa
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Albassam
authors.forename: Abdulmonem
authors.initials: A
authors.lastname: Gado
authors.forename: Mohammed Saquib
authors.initials: MS
authors.lastname: Mallick
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alnaami
authors.forename: Weaam
authors.initials: W
authors.lastname: Al-Shenawy
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D008297:Male; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics