Robot-Assisted Surgery in Pediatric Patients: Results of a French Multicenter Study on 1401 Patients

Abstract

INTRODUCTION: Establishing a robotic program in pediatric surgery remains challenging, with evidence-based practices still evolving. Over the last five years, robot-assisted surgery (RAS) has become the standard approach for several pediatric indications. This study presents the first national analysis of pediatric RAS in France, aiming to evaluate indications, procedural trends, and technical considerations. METHODS: A retrospective, multi-institutional study was conducted across 11 French centers with active pediatric robotic programs over the period 2007-2020. Clinical and organizational data were collected through standardized questionnaires and centralized database analysis. A Surgical Complexity Score (SCS) was developed to classify procedures. RESULTS: A total of 1401 RAS procedures were performed, including 301 children <15 kg and 93 < 10 kg. Centers handled a median of 1.4 cases/month, with 91 types of procedures performed. The 5 most frequent procedures were pyeloplasty (34 %), nephrectomy (12.7 %), antireflux surgery (9.2 %), ureteral reimplantation (5.7 %), and biliary procedures (5.6 %). Over time, procedural complexity increased, with 204 cases classified as high complexity (SCS 3). A strong correlation was observed between center experience and inclusion of patients <15 kg (r = 0.873; p = 0.0004), while conversion rates (3 %) were not influenced by experience. Twenty-four fellows were trained using standardized curricula and dual-console platforms. CONCLUSIONS: Pediatric RAS has significantly grown in France, proving to be safe and feasible even in infants under 10 kg. Urology remains the main indication, followed by gastrointestinal and biliary surgery. Despite current limitations-especially instrument size-RAS offers advantages in precision, ergonomics, and surgical education. Future innovation may enhance its broader adoption in pediatric surgery.