Robotic versus Open Pancreatectomy for Focal Congenital Hyperinsulinism in Infants: A Single-Center Study

Focal forms of congenital hyperinsulinism (FoCHI) are rare pediatric conditions managed using established metabolic and surgical protocols. To date, the use of a robotic approach for this surgery in children has not been described. We present our initial experience with robotic pancreatectomy, compared with the open approach, for the management of FoCHI.We conducted a retrospective, single-center study involving 25 children who underwent pancreatectomy for CHI between 2011 and 2024. Collected data included patient demographics, surgical details, complications, and post-operative outcomes. The Da Vinci Xi robotic system was used for all robotic procedures.Ten patients underwent robotic pancreatectomy, and 10 underwent open surgery; five children treated laparoscopically were excluded. There were no significant differences between the robotic and open groups in median weight at surgery (7.7 kg vs. 7.3 kg, <i>p</i> = 0.7), median age (7 months vs. 5.9 months, <i>p</i> = 0.48), median operative time (298 minutes vs. 285 minutes, <i>p</i> = 0.5), length of stay (14 days vs. 14.5 days, <i>p</i> = 0.26), or time to postoperative feeding resumption (4 days vs. 4.5 days, <i>p</i> = 0.68). Intraoperatively, 80% of lesions were visible on the pancreatic surface. Two cases of incomplete resection occurred in each group; after multidisciplinary review, both patients in the robotic group required a second procedure. No intraoperative bleeding or conversions were reported. The overall cure rate was 90% in the robotic group and 80% in the open surgery group.This preliminary study suggests that robotic pancreatectomy for congenital hyperinsulinism may be both safe and feasible. The robotic approach provides enhanced visualization of small vessels, enabling limited dissection and safe resection. Given the sample size, further studies are required to confirm these findings.