Robot‑assisted thoracoscopic surgery for pediatric mediastinal tumors: a 5‑year experience with 168 cases

Robot-assisted surgery has been increasingly used in pediatric thoracic surgery. This study aimed to assess the safety and feasibility of robot-assisted thoracoscopic surgery (RATS) when applied to mediastinal tumor resection in pediatric patients. This retrospective study included pediatric individuals who underwent robot-assisted thoracoscopic resection of mediastinal lesions at our institution between April 2020 and December 2025, and their clinical records were fully analyzed. We analyzed key indicators, including operation duration, intraoperative hemorrhage, postoperative length of stay, chest tube drainage time, surgical complications and long-term follow-up results. The study cohort comprised 168 children (88 males, 80 females) with a median age of 74 (IQR 45-114) months, a weight of 21.0 (IQR 15.0-31.8) kg, and a median tumor diameter of 4.6 (IQR 3.1-6.3) cm. The median operative time was 94.5 (IQR 73.0-124.8) minutes, with an estimated blood loss of 5.0 (IQR 2.0-8.0) mL. Two patients (1.2%) required conversion to thoracotomy because of massive bleeding and severe adhesions. Postoperatively, 16 patients (9.5%) required intensive care unit (ICU) admission, with a median postoperative hospital stay (PHS) of 6.0 (IQR 5.0-8.0) days. Overall, postoperative complications occurred in 31 patients (19.3%), predominantly Clavien‑Dindo grade II complications (n = 11). Moreover, three Clavien‑Dindo grade IIIb events (1.8%) were observed, comprising two conversions to thoracotomy and one reoperation for recurrent malignancy. On univariate analysis, tumors > 5 cm and malignant pathology were significantly associated with higher complication rates and prolonged hospital stays (all P < 0.05). Furthermore, ICU admissions were significantly higher in patients with tumors > 5 cm. RATS enables safe and minimally invasive resection of pediatric mediastinal tumors in children aged ≥ 4 months or weighing ≥ 7.5 kg, yielding favorable perioperative outcomes. Moreover, tumors > 5 cm and malignant pathology were identified as significant risk factors for adverse perioperative outcomes.