Robot-assisted versus conventional minimally invasive surgery in the treatment of paediatric neuroblastoma: a single-centre retrospective study

Neuroblastoma is the most common extracranial solid tumour in childhood. Although minimally invasive surgery (MIS) is increasingly used in selected patients with neuroblastic tumours, comparative data between robot-assisted and conventional MIS are lacking. A single-centre retrospective study was conducted on 84 patients who underwent minimally invasive resection of neuroblastic tumours between 2008 and 2025. Patients were divided into conventional MIS and robot-assisted surgery groups. Demographic data, tumour characteristics and surgical and oncological outcomes were compared. The robot-assisted group included a higher number of patients with Image-Defined Risk Factor (IDRF) ≥ 1 (57% vs. 8%). Robotic surgery was therefore preferentially employed in more complex cases, resulting in higher conversion rate and longer operative time. Despite the higher prevalence of patients with IDRF ≥ 1 in the robotic group, intraoperative and postoperative complication rates were comparable between groups. Notably, conversions were not performed for emergency reasons but were based on intraoperative decision-making. Robot-assisted surgery may safely expand selection criteria to selected patients with positive IDRFs, while maintaining oncological principles and without increasing intra and postoperative morbidity.