Comparative study of robot-assisted versus laparoscopic surgery for rectovestibular fistula.

OBJECTIVE

To compare perioperative outcomes and 30-day complications between robot-assisted anorectoplasty (RAARP) and laparoscopic-assisted anorectoplasty (LAARP) for rectovestibular fistula (RVF), and exploratorily assess bowel function and operative time trends after RAARP. Comparative evidence specific to RVF remains limited.

METHODS

This single-center retrospective cohort included 63 patients treated during 2019-2024. Given nonrandom treatment and differing enrollment periods, the primary analysis used the contemporaneous 2021-2024 cohort (RAARP, n = 25; LAARP, n = 23). Propensity scores were estimated by Firth bias-reduced logistic regression including calendar year, and overlap weighting estimated the average treatment effect in the overlap population. The primary outcome was total operative time. Core operative time excluded robotic docking time; for LAARP, it equaled total operative time. Thirty-day complications and Krickenbeck bowel function were analyzed exploratorily.

RESULTS

RAARP was associated with longer total operative time (overlap-weighted difference, 18.00 min; 95% CI 9.90 - 26.10; P < 0.001) but shorter core operative time (- 6.81 min; 95% CI - 10.36 to - 3.26; P < 0.001). Docking time averaged 26.24±11.29 min. Postoperative length of stay did not differ significantly (- 0.53 days; 95% CI - 1.52 to 0.46; P = 0.290). Thirty-day complications did not clearly differ, and no fistula recurred. Within the RAARP group, case sequence correlated negatively with total, docking, and core operative times (Spearman ρ = - 0.987, - 0.975, and - 0.896; all P < 0.001). Among 33 patients with complete Krickenbeck assessments, soiling was less frequent after RAARP [1/12 (8.3%) vs 10/21 (47.6%); exploratory P = 0.027], but missing and non-contemporaneous data limited interpretation.

CONCLUSIONS

RAARP had shorter core but longer total operative time because of robotic docking. Operative times decreased across consecutive RAARP cases, although no proficiency threshold was estimated. Functional findings remain exploratory.