Robotic-assisted resection of pediatric intracavitary lesions: expanding the boundaries of minimally invasive surgery

PURPOSE: Describe the implementation of robotic-assisted surgery for pediatric cysts and neoplasms and characterize perioperative outcomes. METHODS: A retrospective review was performed of pediatric patients undergoing robotic-assisted resection of cysts or neoplasms at a quaternary children's hospital from 2011 to 2026. Demographic, lesion, operative, and outcome data were analyzed. RESULTS: Thirty-eight pediatric robotic cases were reviewed. Median age was 13 years (IQR 8.25-16). Eighteen intracavitary cysts and 20 neoplasms were resected. Operations for solid neoplasms consisted of thymectomies (n = 3), mediastinal teratoma excision, lung lobectomy, partial gastrectomy, left hepatectomy, distal pancreatectomy (n = 2), pancreatic uncinate resection, pancreaticoduodenectomy, nephrectomies (2 partial, 2 radical), adrenalectomy, periadrenal mass resection, ovarian cystectomy (n = 2), and radical cystoprostatectomy. Median EBL was 15 mL (IQR 5-25) and day of discharge 1 (IQR 0-2). The median opioid dose prescribed at discharge was 0.28 mg/kg oral morphine equivalents with duration of 1 (0-3) day. Thirty-one (82%) patients experienced no complications. Major complications occurred after pancreatic resections, including hemorrhagic pancreatitis following uncinate resection and delayed biliary stenosis with ductal leak after pancreaticoduodenectomy requiring revision 1.5 years later. CONCLUSION: Robotic-assisted surgery is a safe and feasible option for selected pediatric cysts and neoplasms, offering low blood loss, short hospitalization, and minimal postoperative opioid requirements.