The Advancing Frontier: Robotic-Assisted Laparoscopy in Pediatric Tumor Management

This investigation aims to share our experience with robotic surgery in the diagnostic and therapeutic management of tumor masses in the abdominal or thoracic cavity in children. This illustrative retrospective study, conducted at a single center with the participation of multiple operators, includes pediatric cases operated on between June 2014 and June 2023 for a tumor masses using the Da Vinci Si® surgical robot (Intuitive Surgical®). A total of nine patients, with a median age of 14 years (8-17 years) and a median weight of 57.26 kg (21.5-98 kg), underwent robotic resection of a thoracic mediastinal mass (1 case), an abdominal mass (1 case) or retroperitoneal mass (7 cases). The surgical time ranged from 65 to 433 min, and the tumor size ranged from 18 × 15 × 18 mm to 130 × 145 × 165 mm. Tumor pathologies encompassed a variety of entities, including ganglioneuroma, a paraganglioma, a corticosurrenal adenoma, two mature teratomas, capillary hemangioma of the adrenal gland, epithelial cyst of the spleen, a pheochromocytoma, and a nephroblastoma. Complete excision was achieved in all cases. Intraoperative bleeding occurred but was effectively controlled without the need for conversion. The average hospital stay was 4 days, ranging from 1 to 8 days. All patients were alive at the last follow-up, with no cases of recurrence. In conclusion, robotic surgery has proven to be safe and effective for mass resection in children, particularly for benign cases and in retroperitoneal locations. The benefits of articulated instruments and 3D vision have been especially valuable for precise dissection while maintaining adherence to oncological surgery principles.