title: A Provisional Experience with Robot-Assisted Soave Procedure for Older Children with Hirschsprung Disease: Back to the Future?
abstract: Hirschsprung disease is a congenital disease characterized by intestinal aganglionosis of various extents. Most patients are younger than 1 year of age. Though, a minority of cases can be older or even adult. Older the patient the more difficult and prolonged is the endorectal dissection required for the pull-through procedure. Longer surgery leads to longer anal dilatation and trauma with subsequent higher likelihood of continence impairment. The article aims at describing the first case series of robot-assisted Soave procedure, which was adopted as an alternative minimally invasive approach to older patients with Hirschsprung disease. The technical principles are represented by intraoperative seromuscolar leveling biopsies, intracorporeal endorectal cranial dissection, and endorectal pull-through with colo-anal anastomosis. The authors report three procedures that were carried on without complication with a limited requirement for anal dilatation and trauma, given the reduced need for endorectal caudal dissection. The results demonstrate the feasibility of the proposed approach. The robotic approach should be considered as an alternative minimally invasive approach for older children or adults with Hirschsprung disease.
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .|2 DINOGMI, University of Genoa , Genoa, Italy .
authors.forename: Girolamo
authors.initials: G
authors.lastname: Mattioli
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .|2 DINOGMI, University of Genoa , Genoa, Italy .
authors.forename: Luca
authors.initials: L
authors.lastname: Pio
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .|2 DINOGMI, University of Genoa , Genoa, Italy .
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Leonelli
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Barbara
authors.initials: B
authors.lastname: Razore
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Nicola
authors.initials: N
authors.lastname: Disma
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montobbio
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Jasonni
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Paolo
authors.initials: P
authors.lastname: Petralia
authors.affiliation: 1 Istituto Giannina Gaslini , Genoa, Italy .
authors.forename: Alessio
authors.initials: A
authors.lastname: Pini Prato
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000293:injuries / Q000601:surgery*; D000714:Anastomosis, Surgical; D002675:Child, Preschool; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004106:Dilatation / Q000009:adverse effects; D004210:Dissection / Q000379:methods; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D065287:Robotic Surgical Procedures
keywords: Hirschsprung; Soave; continence; pull-through; robotic surgery