Comparison of robotic-assisted and laparoscopic-assisted surgery in the treatment of children with Hirschsprung's disease: a systematic review and meta-analysis
Bibliographic record
Abstract
Background 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. Methods 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 (NOS). RevMan5.4 and STATA18 were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), with heterogeneity and publication bias evaluated. Results 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, P = 0.02) but longer operative duration (OR = 19.74, 95%CI: 1.75–37.72, P = 0.03). No significant group differences were found in postoperative enterocolitis (OR = 0.66, 95%CI: 0.43–1.01, P = 0.06), anastomotic complications (OR = 0.71, 95%CI: 0.35–1.45, P = 0.35), soiling (OR = 0.79, 95%CI: 0.39–1.60, P = 0.51), adhesive intestinal obstruction (OR = 1.56, 95%CI: 0.22–11.32, P = 0.66), wound infection (OR = 0.77, 95%CI: 0.19–3.01, P = 0.70), incisional hernia (OR = 1.13, 95%CI: 0.20–6.40, P = 0.89), perianal infection (OR = 0.70, 95%CI: 0.40–1.23, P = 0.22), urinary retention (OR = 0.23, 95%CI: 0.01–3.59, P = 0.29), or gastrointestinal function recovery time (OR = −1.27, 95%CI: −3.70–1.15, P = 0.30). Hospital stay was significantly shorter in the RAS group (OR = −0.39, 95%CI: −0.69–−0.10, P = 0.009). Egger's test and funnel plot analysis indicated no significant publication bias (P = 0.987). Conclusions 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. Systematic Review Registration PROSPERO CRD420251051595.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.032 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.036 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".