Robotic approach for Wilms' tumour: Patient selection, technical considerations, and outcome analysis

Robotic assisted surgery (RAS) is increasingly used in paediatric surgery. Its role in tumour surgery remains selective and debatable. Despite a few publications on the feasibility and safety of minimally invasive approaches for solid tumour surgery, there is debate about its role in view of the risks of vascular injury, tumour rupture, lymph node sampling, and tumour recurrence on long term follow up.

This study aimed to evaluate the feasibility, safety, and oncologic outcomes of robotic surgery with long term follow up in selected cases of Wilms tumour and compare these outcomes with those of open surgery performed during the same period.

A retrospective review of a prospectively maintained database was performed for children with Wilms tumour treated between 2013 and 2025. Patients with metastatic disease, residual disease, vascular thrombus, or extrarenal extension were excluded. Robotic surgery was offered for tumours confined to the kidney with predefined selection criteria of age ≥6 months, weight ≥6 kg, and tumour size ≤6 cm in the largest diameter, including those downsized after chemotherapy. Outcomes were compared descriptively with open surgery.

Thirty three patients underwent surgery. Twelve patients underwent robotic surgery, and 21 underwent open surgery. After exclusions of 8 cases, 12 robotic and 13 open cases were analysed. The median tumour size was smaller in the robotic group (4.2 cm vs. 7.5 cm). The median blood loss was lower in the robotic group (2.1 vs. 4.25 mL/kg). The median hospital stay was shorter (3.4 vs. 10 days). Lymph node sampling was performed in all patients. All margins were negative. One case of capsular rupture, one transient urine leak after partial nephrectomy, and one conversion occurred in the robotic group. At a median follow up of 5.7 years, oncologic outcomes were similar and acceptable in both groups.

Robotic surgery for carefully selected Wilms tumours confined to the kidney is feasible, safe, and has comparable long term outcomes. Careful patient selection and adherence to oncologic principles remain essential.