Robotic-assisted thoracic surgery in children with congenital lung disease: advancements, challenges, and future directions.

Background: Congenital lung disease (CLD), including congenital pulmonary airway malformation and pulmonary sequestration, is increasingly diagnosed with advances in prenatal and postnatal imaging. Video-assisted thoracoscopic surgery (VATS) is widely accepted as the standard minimally invasive approach. Robotic-assisted thoracic surgery (RATS) has emerged as an alternative platform, but its role in pediatric pulmonary resection remains to be defined. Methods: A narrative review was conducted using PubMed from database inception to February 2026. Search terms included "robotic-assisted thoracic surgery," "pediatric," and specific congenital lung anomalies. Clinical studies, comparative cohorts, and case series reporting RATS for pediatric CLD were included. Findings were qualitatively synthesized. Results: Three studies were included, all of which were comparative cohorts. Robotic resections were mainly performed for congenital pulmonary airway malformation and pulmonary sequestration. The youngest reported patient was 6 months old (8 kg). Conversion rates were low (1%-3%), and major intraoperative complications were uncommon. Postoperative recovery was acceptable, with short hospital stays and predominantly minor complications. Comparative analyses showed similar perioperative safety profiles between RATS and VATS, although operative times were generally longer with RATS. Reported advantages of RATS included enhanced three-dimensional visualization, improved instrument articulation, and ergonomic benefits. Conclusions: RATS is a feasible and safe option for selected pediatric patients with CLD. While short-term outcomes are comparable to VATS, clear superiority has not been demonstrated. Prospective multicenter studies and long-term functional evaluation are required to define its role in pediatric thoracic surgery.