Robotic-assisted surgery in children under 10 kg: a systematic review.

introductionRobotic surgery has been progressively adopted in pediatric patients over recent years, accompanied by a reduction in the age and weight of those treated, as well as an expansion of surgical indications in increasingly smaller children.

methodsA systematic review was conducted in accordance with PRISMA guidelines, searching PubMed, CINAHL, Web of Science and EMBASE for studies on robotic-assisted surgery in children weighing under 10 kg, registered in PROSPERO (CRD420251110421). Two reviewers independently screened all records against predefined inclusion criteria. Extracted data included study design, patient demographics, surgical indications, intraoperative variables, and perioperative outcomes.

resultsA total of 37 articles, comprising 1,437 pediatric patients under 10 kg and published between 2007 and 2025, met the inclusion criteria for narrative synthesis in our systematic review. Of these, 18 (48.6%) were retrospective descriptive analyses, 14 (37.8%) were retrospective comparative studies, and 5 (13.5%) were case reports. Robotic surgery indications were grouped into five categories: congenital diaphragmatic anomalies, addressed in two studies (5.4%); gastrointestinal disorders, reported in eight studies (21.6%); hepatobiliary procedures-including biliary atresia and choledochal cyst excision-featured in eleven studies (29.7%); colorectal procedures, such as anorectal malformations and Hirschsprung's disease, reported in seven studies (18.9%); and urological procedures, described in nine studies (24.3%). A total of 89 postoperative complications (9.6%) and 10 conversions (1.1%) were reported.

conclusionsRobotic surgery in patients weighing less than 10 kg has multiple indications, including thoracic, gastrointestinal, hepatobiliary, colorectal, and urological procedures. It seems to be a safe and effective approach in this population, with low conversion and postoperative complication rates. The lack of comparative and prospective studies, along with the heterogeneity of procedures, are the main limitations.