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.
J Pediatr Surg. 2011 Sep;46(9):1794-7. doi: 10.1016/j.jpedsurg.2011.04.019.
BACKGROUND/PURPOSE: 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).
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.
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.
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.
背景/目的：许多报告已经探讨了在儿童中使用机器人手术的可行性和安全性。据我们所知，尚无文献报道使用手术机器人修复直肠尿道瘘型肛门直肠畸形（ARM）。
2006 年 4 月至 2010 年 3 月，沙特阿拉伯利雅得的 King Khalid 大学医院采用达芬奇外科系统对 5 例男性 ARM 合并直肠尿道瘘患儿行机器人辅助修复术，回顾性分析其临床资料，包括人口统计学数据、合并畸形、手术技术和操作步骤、并发症、治疗结果和随访情况。
5 例 ARM 合并直肠尿道瘘患儿（平均年龄 6.6 个月）采用 Georgeson 技术行机器人辅助修复术。4 例患儿瘘管切开结扎，1 例瘘管旷置。所有患儿均顺利完成手术，无中转开放手术。术后 1 例患儿出现左侧附睾睾丸炎。所有患儿均完成结肠造口还纳术。随访时间 6~36 个月。2 例患儿大便控制情况难以评估，2 例患儿可自主控制排便，无大便失禁，1 例患儿大便失禁，因便秘给予通便灌肠治疗。
机器人辅助修复直肠尿道瘘型 ARM 是可行和安全的，为 ARM 合并直肠尿道瘘的治疗提供了一种替代后矢状入路肛门直肠成形术（PSARP）的方法。需要更多的患者和更长的随访时间来进一步评估这种新方法。
