Robotic-Assisted Removal of Gastric Bezoars in Children: Feasibility and Technical Evolution in a Case Series

Gastric bezoars are rare entities usually affecting young girls, frequently associated with underlying psychological disorders. Although open gastrotomy has historically been the gold-standard treatment, minimally invasive techniques are increasingly being used. This study aimed to evaluate the feasibility and outcomes of robotic-assisted laparoscopic removal of gastric bezoars in pediatrics, with particular attention to trocar configuration strategies.

Retrospective monocentric study between 2015 and 2025. Four girls underwent robotic surgery using the Da Vinci Xi^® platform. In the first two, trocars were positioned along the transumbilical plane. In the last two cases, trocars configuration was changed, consisting of a transumbilical camera port followed by placement of three additional 8-mm robotic trocars along the Pfannenstiel line. Surgical management consisted of gastrotomy and bezoar extraction using an endobag through a Pfannenstiel incision.

Median age was 10.9 years (IQR: 8-12), with a median weight of 38 kg (IQR: 34-43). All bezoars were gastric, with in one an associated jejunal extension. Median operative time was 282 minutes (IQR: 210-318). No intraoperative complications occurred. One patient developed a postoperative sub-occlusion managed medically. Median hospital stay was 5.5 days (IQR: 4.5-7.5). At a median follow-up of 3 years, all patients remained asymptomatic. The suprapubic trocar configuration provided satisfactory exposure and allowed extraction through concealed incisions.

Robotic-assisted laparoscopic management of gastric bezoars appears feasible and safe. Given the frequent psychological vulnerability of the patients affected, reducing visible scarring may represent an additional advantage over conventional laparotomy or standard robotic approaches.