Background: Robotic-assisted surgery (RAS) holds many theoretical advantages, especially in pediatric surgical procedures. However, most robotic systems are dedicated to adult surgery and are less suitable for smaller children. The Senhance^® Surgical System (SSS^®), providing 3 mm and 5 mm instruments, focuses on making RAS technically feasible for smaller children. This prospective observational study aims to assess whether RAS in pediatric patients using the SSS^® is safe and feasible. Methods and Results: A total of 42 children (aged 0–17 years, weight ≥ 10 kg) underwent a RAS procedure on the abdominal area using the SSS^® between 2020 and 2023. The study group consisted of 20 male and 22 female individuals. The mean age was 10.7 years (range 0.8 to 17.8 years), with a mean body weight of 40.7 kg (range 10.1 to 117.3 kg). The 3-mm-sized instruments of the SSS^® were used in 12 of the 42 children who underwent RAS. The RAS procedures were successfully completed in 90% of cases. The conversion rate to conventional laparoscopy was low (10%), and there were no conversions to open surgery. One of the 42 cases (2%) experienced intraoperative complications, whereas six children (14%) suffered from a postoperative complication. Overall, 86% of the patients had an uncomplicated postoperative course. Conclusions: The results of the current observational study demonstrate the safety and feasibility of utilizing the SSS^® for abdominal pediatric RAS procedures. The study provides new fundamental information supporting the implementation of the SSS^® in clinical practice in pediatric surgery.

Background: The effect of pediatric inguinal hernia repair (IHR) on testicular vascularization remains unclear. Manipulating the spermatic cord during surgery may reduce blood flow due to edema and vasoconstriction. This can lead to testicular atrophy. The study aims to review current knowledge of testicular vascular impairment following IHR in children. Methods: A systematic literature search was conducted in PubMed/Medline, Embase, Cochrane Library, and Web of Science. Methodological quality was assessed using validated tools. Data were extracted, and a pooled data analysis was performed. Results: Ten studies were included in the systematic review. Six of these studies were eligible for meta-analysis. This revealed a significant decrease in testicular vascularization during the short-term follow-up (1 day–1 week) after IHR using the open surgical approach. This decrease was not present after laparoscopic intervention. There was no more increased resistance in the vessels at long-term follow-up (1 month–6 months), suggesting that the impaired vascularity is only temporary. Conclusions: There seems to be a short-term transient vascular impairment of the testis after open IHR in children. This might be of clinical relevance to prefer the laparoscopic approach for IHR in children, even though the open approach is the gold standard, in contrast to adult IHR. The impact on testicular function and sperm quality later in life remains unclear. Comparative studies of both techniques are needed to determine if there is a significant difference in testicular vascularity. Long-term studies are necessary to assess the impact of transiently reduced vascularity on sperm quality and fertility later in life.

Background: Nissen Fundoplication (NF) is a frequently performed procedure in children. Robotic-assisted Nissen Fundoplication (RNF), with the utilization of the Senhance^® Surgical System (SSS^®) (Asensus Surgical^® Inc., Durham, NC, USA) featuring 3 mm instruments, aims to improve precision and safety in pediatric surgery. This matched cohort study assesses the safety and feasibility of RNF in children using the SSS^®, comparing it with Laparoscopic Nissen Fundoplication (LNF). Methods and Results: Twenty children underwent RNF with the SSS^® between 2020 to 2023 and were 1:1 matched with twenty LNF cases retrospectively selected from 2014 to 2023. Both groups were similar regarding male/female ratio, age, and weight. Two of the twenty RNF cases (10%) experienced intraoperative complications, whereas three in the LNF group of whom two required reinterventions. The observed percentage of postoperative complications was 5% in the RNF group compared to 15% in the LNF group (p = 0.625). The operative times in the RNF group significantly dropped towards the second study period (p = 0.024). Conclusions: Utilizing SSS^® for NF procedures in children is safe and feasible. Observational results may tentatively suggest that growing experiences and continued development will lead to better outcomes based on more accurate and safe surgery for children.

Introduction: Inguinal hernia repair (IHR) is one of the most common procedures in pediatric surgery. In children, the application of robotic surgery is limited, meaning safety and efficacy is still to be assessed. This report is the first one worldwide that describes inguinal hernia repair in children using the Senhance^® Surgical System (SSS^®). The aim of this matched cohort study is to assess safety and feasibility of robot-assisted IHR (RIHR) in children, compared to conventional laparoscopic IHR (LIHR). Patients and methods: This pilot study included 26 consecutive patients between 3 months and 8 years old who underwent RIHR (31 IH’s) with the SSS^® between 2020 and 2024. These cases were matched based on gender, age, and unilateral or bilateral IH, with 26 patients (32 IH’s) who underwent conventional LIHR. Results: There was a significant difference in total anesthesia time, which is most likely due to the extra time needed to dock the robot in the RIHR cases. No significant difference was seen in surgical time. One recurrence (3.2%) was diagnosed in both groups. One patient in the LIHR group was readmitted on the day of discharge due to a hemorrhage. No intervention was necessary, and the patient was discharged 1 day later. Discussion: In this pilot study, the use of the robotic system was safe and feasible. More experience, further improvement of the system for use in very small children, and investigation in a larger sample size with long-term follow-up is necessary to evaluate efficacy.

Introduction Minimally invasive surgery (MIS) has improved patient outcomes by reducing surgical trauma and recovery times. Robotic-assisted surgery (RAS) advances MIS with superior precision, visualisation and ergonomics. These advantages are especially critical in paediatric procedures. The Senhance Surgical System (SSS) is a CE-marked robotic platform that enables RAS in children using 3 mm and 5 mm instruments. While RAS is routinely established in many adult procedures, its adoption and documentation in paediatric surgery are lagging. To address this disparity, the MiniTrust registry will generate real-world evidence on the safety and performance of the SSS in paediatric procedures. Methods and analysis This multicentre, observational post-market clinical follow-up (PMCF) registry study includes both prospective and retrospective cases of paediatric patients undergoing RAS in urology, gynaecology or general surgery. If the underlying diagnosis is suitable for treatment with RAS, patients under 18 years of age and weighing ≥10 kg are eligible. Primary outcomes include procedure-related adverse events (AEs) classified as Clavien-Dindo >grade III within 30 days, and serious AEs within 3 months. Secondary endpoints include length of hospital stay, unplanned conversion rates and patient-reported pain outcomes. Data are collected via standardised case report forms and analysed descriptively, with results benchmarked against conventional paediatric laparoscopy literature. Ethics and dissemination This study was approved in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Maastricht (2024–0425) and by the Ethics Committee of Munich (2024–0589). Results will be disseminated through peer-reviewed publications, scientific conferences and regulatory reports. This registry will contribute essential evidence to support the broader integration of RAS into paediatric surgical care. Trial registration number NCT07081828.

Our previous studies indicated that the Senhance ^® Surgical System (SSS ^® ) is safe and feasible for a wide spectrum of abdominal indications in children, with results comparable to conventional laparoscopy. This multicenter cohort study represents the largest published series of pediatric Robotic-Assisted Surgery (RAS) procedures performed with the SSS ^® to date and complements the existing evidence, which is currently based on single-center studies. A total of 152 pediatric patients underwent a variety of RAS procedures (including upper abdominal-, lower abdominal-, and thoracic procedures) using the SSS ^® between 2020 and 2025 at two European tertiary referral centers and were consecutively enrolled in the study and analyzed. Of these, 23 children (15%) were younger than 1 year old and/or weighed less than 10 kg at the time of surgery. Conversion from RAS to conventional laparoscopy occurred in 17 cases (11%), with a significantly lower rate observed in lower abdominal procedures, and most often due to suboptimal trocar placement. Only one case was converted to an open procedure, with no conversions in the small children subgroup. Intraoperative- and postoperative complication rates were low, regardless of procedure type or patient age. Mean docking time decreased progressively over the course of the study (p = < 0.001). Utilization of SSS ^® for RAS is safe and feasible across the entire pediatric spectrum of surgical procedures and patients, including infants younger than one year and children weighing less than ten kilograms. With increasing experience, the SSS ^® has significant potential to advance minimally invasive surgery in children.