Outcomes of robotic-assisted soave pull-through procedure for Hirschsprung disease: a systematic review and meta-analysis.

Pull-through procedures remain the mainstay of treatment for Hirschsprung disease (HD). While laparoscopic-assisted procedures are widely performed, robotic-assisted Soave pull-through (RSPT) has emerged as a minimally invasive alternative with potential technical advantages. We systematically reviewed the available literature to evaluate the perioperative and functional outcomes of RSPT. PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov were systematically searched through February 2025. Eligible studies included pediatric (< 18 years) patients undergoing RSPT. Data were pooled using random-effects models with two heterogeneity estimators to ensure robustness given the small number of included studies. Heterogeneity was assessed using I2 and τ² statistics. Primary outcomes included operative time, console time, intraoperative blood loss, and length of stay (LOS). Secondary outcomes included constipation, enterocolitis, and soiling. Study quality was assessed using the National Institutes of Health (NIH) Quality Assessment Tool. Six retrospective studies comprising 282 patients were included. Pooled mean operative and console times were 192.2 min (95% CI: 95.2-388.0) and 105.6 min (95% CI: 34.7-321.5), respectively. Mean intraoperative blood loss was 9.8 mL (95% CI: 1.9-49.4), and pooled postoperative LOS was 6.5 days (95% CI: 4.6-9.1). No difference in estimates was observed by estimator models. Postoperative complications were typically mild, manageable conservatively, and improved over time. RSPT appears to be a feasible minimally invasive option for HD, demonstrating low blood loss, short hospital stay, and acceptable functional outcomes, albeit with longer operative times which reflect logistical rather than technical inefficiency. Future adequately powered, higher quality, multicenter trials with standardized outcomes are needed to better define its role relative to established laparoscopic approaches.