An international multicenter experience with the Senhance® Surgical System in pediatric surgery: Analysis of the first 150 pediatric procedures

Our previous studies indicated that the Senhance® Surgical System (SSS®) is safe and feasible for a wide spectrum of abdominal indications in children, with results comparable to conventional laparoscopy. This multicenter cohort study represents the largest published series of pediatric Robotic-Assisted Surgery (RAS) procedures performed with the SSS® to date and complements the existing evidence, which is currently based on single-center studies. A total of 152 pediatric patients underwent a variety of RAS procedures (including upper abdominal-, lower abdominal-, and thoracic procedures) using the SSS® between 2020 and 2025 at two European tertiary referral centers and were consecutively enrolled in the study and analyzed. Of these, 23 children (15%) were younger than 1 year old and/or weighed less than 10 kg at the time of surgery. Conversion from RAS to conventional laparoscopy occurred in 17 cases (11%), with a significantly lower rate observed in lower abdominal procedures, and most often due to suboptimal trocar placement. Only one case was converted to an open procedure, with no conversions in the small children subgroup. Intraoperative- and postoperative complication rates were low, regardless of procedure type or patient age. Mean docking time decreased progressively over the course of the study (p = < 0.001). Utilization of SSS® for RAS is safe and feasible across the entire pediatric spectrum of surgical procedures and patients, including infants younger than one year and children weighing less than ten kilograms. With increasing experience, the SSS® has significant potential to advance minimally invasive surgery in children.