Robot-Assisted Pull-Through for Anorectal Malformations: Comparative Observational Study of Functional Outcomes with an Open Approach.

Introduction: Robotic surgery has gained acceptance in the field of pediatric surgery but is still under assessment. Some limitations of this device are particularly encountered when performing specific tasks in small cavities, such as neonatal pelvis. The aim of this study was to compare the functional results of robot-assisted anorectal pull-through (RAARP) with posterior sagittal anorectoplasty (PSARP) in children with "high" types of anorectal malformations (ARMs). Materials and Methods: In this multicenter experience, we reviewed the patients operated for ARMs using the da Vinci® system between 2007 and 2020 in our national robotic program. Two groups of patients according to the surgical technique (robotic versus open) were compared based on the postoperative outcomes and long-term functional results using Kelly and Krickenbeck scores at 3 years of age. Results: Ten patients operated using RAARP were compared with 10 patients operated using PSARP (mean weight 8.1 ± 1.2 kg versus 8.6 ± 1.1 kg, respectively). The two groups were comparable in terms of the ARM classification and patient demographics. The clinical Kelly score was significantly lower for the PSAAP group (P = .012). The Krickenbeck constipation score was significantly lower for the RAARP group (P = .02), whereas no statistical difference was found for the soiling score and voluntary bowel movements. Conclusions: A concomitant laparoscopic approach using a robotic platform appears to be an alternative technique to the criterion standard for performing anorectal malformation surgery with satisfactory functional results. The enhanced potential of preserving perirectal nerves requires confirmation through longer follow-up studies focusing on functional assessment.