Seven years of pediatric robotic-assisted surgery: insights from 105 procedures

Robotic-assisted surgery (RAS) has recently expanded its role in pediatric patients. We conducted a retrospective review of 105 cases over 7 years (2017-2024) to evaluate outcomes, efficiency, and training experiences. A total of 105 children (58 boys, 47 girls) aged 2-15 years underwent robotic-assisted procedures using the Da Vinci Xi system. The most common indications were ureteropelvic junction obstruction (n = 33), varicocele (n = 29), and primary obstructive megaureter (n = 16). Two senior surgeons performed the procedures, training seven junior surgeons via the dual-console system. Statistical analysis included paired t-tests for docking time and operative duration comparisons, and Fisher's exact test for categorical variables. Docking time significantly improved over time from 45 to 15 min (median 25 min) (p = 0.001). The total operative time significantly decreased over time (p = 0.001), with a median of 125 min (range 50-250). Robotic system-related issues were reported in 3/105 (2.8%). Conversion to laparoscopy was necessary in 1 (0.9%). Postoperative complications (Clavien grade 3b) occurred in 2/105 (1.8%) patients, requiring reintervention. The median hospital stay was 2 days (range 1-7). Monthly case volume increased from 1-2 to 4-7. Our 7 year experience with pediatric RAS demonstrates its safety, effectiveness, and growing role, especially in pediatric urology. It offers ergonomic advantages and facilitates training but is still limited by cost, larger instrument size (8 mm), and longer setup times compared to laparoscopy. Future developments, such as smaller robotic instruments and single-port technology, may help overcome these limitations and expand the applicability of RAS to younger and smaller patients.