Increasing Role of Robotic-assisted Surgery in Children: Literature Review

Abstract

Robotic-assisted surgery has significantly transformed pediatric surgery by enhancing the precision and ergonomics of minimally invasive procedures led to improved outcomes, particularly in complex reconstructive operations. This narrative review evaluates the current landscape, clinical outcomes, technological developments, and broader considerations associated with robotic surgery in children with pediatric urology representing the most developed and well-documented domain of its application. A comprehensive literature search was conducted across PubMed, MEDLINE, and Google Scholar between December 7–10, 2024. Studies involving patients under 18 years, published from 2020 to 2024, were included.  After screening 93 articles, 47 met the inclusion criteria and were analyzed for clinical effectiveness, complications, operative metrics, and broader implications. Pyeloplasty and ureteral reimplantation emerged as the most common robotic procedures, demonstrating high success rates and low complication rates. Emerging applications include complex reconstructions, salvage procedures, and image-guided surgery with indocyanine green fluorescence. New robotic platforms, such as single-port systems, aim to improve ergonomics and adaptability for pediatric anatomy, although cost and regulatory barriers persist. Robotic surgery in children offers consistently favorable clinical outcomes with growing procedural diversity. While barriers such as costs and limited pediatric-specific tools remain, innovation and high-volume practices suggest a promising trajectory. Broader adoption will require multicenter prospective trials, standardized reporting, pediatric-specific instrumentation, and cost-reduction strategies.