Pediatric Robotic Gynecologic Surgery: A Retrospective Institutional Experience and Systematic Review.

Introduction: While robotic-assisted surgery has been shown to be safe and feasible for various pediatric conditions, its applicability in pediatric gynecologic surgery remains understudied in pediatric populations. This study contributes institutional data and a literature review to assess the feasibility, safety, and clinical role of robotic surgery in pediatric gynecology.

Materials and methods: We conducted a retrospective analysis of medical records from our institution over the past decade, focusing on all girls undergoing robotic gynecological procedures. Parameters such as operative time, length of hospital stay (LOS), complication rate, conversion rate, and pathology were assessed.

Results: Twenty-nine girls (median age 13.15 years, median weight 52 kg) underwent various robotic procedures including ovarian cystectomy (n=15), tubal/paratubal cyst excision (n=6), salpingo-oophorectomy for complex masses (n=2), gonadectomy for gonadal dysgenesis (n=2), robotic excision of uterine horn for bicornuate uterus (n=2) and removal of Müllerian remnants (n=2). Median operative time was 103 minutes, with no conversions. Median LOS was 2 days (range 1-5). One minor complication was recorded (Clavien Dindo I) (1/29, 3.4%).

Conclusions: Our review of 29 pediatric patients highlights the safety and efficiency of a robot-assisted approach to pelvic and internal female genitalia procedures, with a zero-major complication rate across all cases. These findings support the feasibility of robotic surgery in managing complex gynecological conditions in children. However, definitive evidence comparing its outcomes to traditional laparoscopy is still lacking. Well-designed prospective, randomized studies are essential to establish the gold standard for these indications.