Comparison of robotic versus thoracoscopic repair for congenital esophageal atresia: a propensity score matching analysis

Background: Despite the rapid advancement of robotic surgery across various surgical domains, only cases of robotic repair (RR) for neonates with esophageal atresia (EA) have been reported. Comprehensive studies comparing RR and thoracoscopic repair (TR) are lacking. We aimed to compare the safety and efficacy of RR and TR for EA. Methods: A retrospective multicenter study was conducted on 155 EA neonates undergoing RR (79 patients) or TR (76 patients) between August 2020 and February 2023 using propensity score matching (PSM). Asymmetric port distribution and step-trocar insertion techniques were applied during RR. Demographics and surgical outcomes were compared. Results: After matching, 63 patients (out of 79) in RR group and 63 patients (out of 76) in TR group were included. There were no significant differences in short-term outcomes between two groups, except for longer total operative time (173.81 vs. 160.54 min; P <0.001) and shorter anastomotic time (29.52 vs. 40.21 min; P <0.001) in RR group. Compared with TR group, the RR group had older age at surgery (8.00 vs. 3.00 d; P <0.001), but a comparable pneumonia rate. More importantly, the incidence of anastomotic leakage (4.76% vs. 19.05%, P =0.013), anastomotic stricture (15.87% vs. 31.74%, P =0.036) within one year postoperatively, and unplanned readmission (32.26% vs. 60.00%, P =0.030) within two years postoperatively were lower in RR group than in TR group. Conclusions: RR is a technically safe and effective option for EA patients. This approach delays the age of surgery without increasing respiratory complication rates while reducing the incidence of postoperative anastomotic complications and unplanned readmission.