Exploring the future of robotic approaches in neonatal cardiac surgery: opportunities, barriers, and innovation pathways

Robotic-assisted surgery (RAS) emerged as a transformative approach in various surgical disciplines, particularly in adult cardiothoracic procedures, where it has demonstrated significant benefits such as enhanced precision, improved visualisation, and reduced complication rates. Despite its success in adult surgeries, including mitral valve repairs and coronary artery revascularisations, the application of RAS in neonatal cardiothoracic surgery remains largely unexplored. This narrative review synthesises existing evidence, highlighting the potential of RAS to address the unique challenges posed by neonatal cardiothoracic procedures, which require intricate manoeuvrability and precision within confined anatomical spaces. The review also examines the successes of minimally invasive techniques, such as laparoscopic and thoracoscopic surgeries, in paediatric patients, particularly those with congenital heart disease (CHD), demonstrating their safety and efficacy even in high-risk populations. These findings suggest that RAS could offer similar, if not superior, benefits in neonatal cardiothoracic surgeries in future. Significant gaps in the literature, particularly regarding long-term outcomes and the technical challenges of RAS adaptation for neonatal use, underscore the need for further research. Likewise, technological iterations in the currently available systems (including instrument size and curvature, scope definition and haptic feedback) are required to make this concept a reality by meeting the standard of care. This review argues that while RAS holds considerable promise for improving surgical outcomes in neonates, dedicated research is essential to overcome and fully realise its potential. This review not only underscores the current successes of RAS in adult and paediatric surgeries but also sets a foundation for future exploration into its application in neonatal cardiothoracic procedures, advocating for continued innovation and research in this promising field.