Current Status of Pediatric Robot-Assisted Surgery in Italy Part 2: National Survey on a 5-Year Period 2020–2025

<b><i>Introduction:</i></b> Following a previous study focused on the status of robotic surgery in Italy in 2020, we aimed to present the updated study reflecting data up to 2025. <b><i>Patients and Methods:</i></b> An online questionnaire has been sent to robotic pediatric centers in Italy. The duration of robotic activity, the number of surgeons performing robot-assisted surgery (RAS), the modality of training, volume, type, and outcome of RAS in each participating center have been collected and analyzed. <b><i>Results:</i></b> The number of centers practicing robotic surgery in Italy increased by 55.5% rate. All 14 centers adopted the Da Vinci Intuitive console. Three out of 14 centers have a dedicated console, while 11 out of 14 centers share the robotic platform with adult surgeons. Nine out of 14 centers routinely adopted a fourth 5-mm laparoscopic trocar for the bedside surgeon. About 1105 robotic procedures have been performed, the majority were still urological (46.7%). The others were gastrointestinal 18%, oncological 17.1%, gynecological 10.9%, and thoracic 3.6%. The rest (3.7%) were considered varia. All centers prefer to operate patients weighing more than 10-15 kg. <b><i>Conclusions:</i></b> Robotic pediatric activity in Italy has had an important development in the last 5 years. Although there has been a significant increase, the majority of centers (78.6%) have a minimal robotic activity. Future directions are going to be the presence of robotic platforms in every pediatric centers; in this way, the robots can be adopted routinely in the pediatric surgical practice as laparoscopy. For pediatric surgery, we also need smaller instruments because 8 mm cannot be adopted in neonates and smaller infants.