Li Zikang, Li Wanfu, Wang Haojun, Xu Mengxue
Department of Pediatric General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Front Pediatr. 2025 Aug 6;13:1638198. doi: 10.3389/fped.2025.1638198. eCollection 2025.
This study aims to systematically evaluate the differences between robotic-assisted surgery (RAS) and laparoscopic-assisted surgery (LAS) in intraoperative parameters, postoperative complications, and prognostic outcomes for children with Hirschsprung's disease (HSCR). By conducting a meta-analysis, evidence-based insights for clinical practice were sought.
Following PRISMA guidelines, PubMed, Embase, and Web of Science were searched up to May 10, 2025, to identify comparative studies of RAS and LAS for HSCR. Two reviewers independently screened literature and assessed quality using the Newcastle-Ottawa Scale (OS). RevMan5.4 and STATA18 were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), with heterogeneity and publication bias evaluated.
Six studies involving 789 children (352 RAS, 437 LAS) were included. Meta-analysis showed significantly less intraoperative blood loss in the RAS group (OR = -6.45, 95%CI: -11.77 to -1.14, = 0.02) but longer operative duration (OR = 19.74, 95%CI: 1.75-37.72, = 0.03). No significant group differences were found in postoperative enterocolitis (OR = 0.66, 95%CI: 0.43-1.01, = 0.06), anastomotic complications (OR = 0.71, 95%CI: 0.35-1.45, = 0.35), soiling (OR = 0.79, 95%CI: 0.39-1.60, = 0.51), adhesive intestinal obstruction (OR = 1.56, 95%CI: 0.22-11.32, = 0.66), wound infection (OR = 0.77, 95%CI: 0.19-3.01, = 0.70), incisional hernia (OR = 1.13, 95%CI: 0.20-6.40, = 0.89), perianal infection (OR = 0.70, 95%CI: 0.40-1.23, = 0.22), urinary retention (OR = 0.23, 95%CI: 0.01-3.59, = 0.29), or gastrointestinal function recovery time (OR = -1.27, 95%CI: -3.70-1.15, = 0.30). Hospital stay was significantly shorter in the RAS group (OR = -0.39, 95%CI: -0.69--0.10, = 0.009). Egger's test and funnel plot analysis indicated no significant publication bias ( = 0.987).
RAS confers advantages in reducing intraoperative blood loss and shortening hospital stay, although it is associated with a longer operative duration. However, no significant difference in the incidence of postoperative complications was noted between RAS and LAS, a finding potentially attributable to the limited sample size. Furthermore, the currently elevated treatment cost of RAS may impede its widespread adoption due to economic limitations. Consequently, large-sample, multicenter randomized controlled trials with extended follow-up periods are warranted to validate long-term outcomes and conduct in-depth investigations into cost-effectiveness.
PROSPERO CRD420251051595.
本研究旨在系统评估机器人辅助手术（RAS）与腹腔镜辅助手术（LAS）在先天性巨结肠症（HSCR）患儿的术中参数、术后并发症及预后结果方面的差异。通过进行荟萃分析，寻求基于证据的临床实践见解。
按照PRISMA指南，检索截至2025年5月10日的PubMed、Embase和Web of Science，以确定RAS和LAS用于HSCR的比较研究。两名审阅者独立筛选文献并使用纽卡斯尔-渥太华量表（NOS）评估质量。使用RevMan5.4和STATA18计算比值比（OR）和95%置信区间（CI），并评估异质性和发表偏倚。
纳入6项研究，共789例患儿（RAS组352例，LAS组437例）。荟萃分析显示，RAS组术中出血量显著减少（OR = -6.45，95%CI：-11.77至-1.14，P = 0.02），但手术时间较长（OR = 19.74，95%CI：1.75 - 37.72，P = 0.03）。术后小肠结肠炎（OR = 0.66, 95%CI：0.43 - 1.01, P = 0.06）、吻合口并发症（OR = 0.71, 95%CI：0.35 - 1.45, P = 0.35）、污粪（OR = 0.79, 95%CI：0.39 - 1.60, P = 0.51）、粘连性肠梗阻（OR = 1.56, 95%CI：0.22 - 11.32, P = 0.66）、伤口感染（OR = 0.77, 95%CI：0.19 - 3.01, P = 0.70）、切口疝（OR = １.13, 95%CI：0.20 - 6.40, P = 0.89）、肛周感染（OR = 0.70, 95%CI：0.40 - 1.23, P = 0.22）、尿潴留（OR = 0.2３, 95%CI：0.01 - 3.59, P = 0.29）或胃肠功能恢复时间（OR = -1.27, 95%CI：-3.70 - 1.15, P = 0.30）方面，两组间无显著差异。RAS组住院时间显著缩短（OR = -0.39, 95%CI：-0.69 - -0.10, P = 0.009）。Egger检验和漏斗图分析表明无显著发表偏倚（P = 0.987）。
RAS在减少术中出血量和缩短住院时间方面具有优势，尽管其与较长的手术时间相关。然而，RAS和LAS术后并发症发生率无显著差异，这一发现可能归因于样本量有限。此外，目前RAS较高的治疗成本可能因其经济限制而阻碍其广泛应用。因此，有必要进行大样本、多中心随机对照试验，并延长随访期以验证长期结果，并对成本效益进行深入研究。
PROSPERO CRD420251051595
