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: 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.

Background: Inguinal hernia repair (IHR) is frequently performed in infants, often under general anesthesia. Preterm infants are routinely monitored for 24 h postoperatively, due to high reported rates of respiratory complications. However, recent data suggest a decline in these events, prompting a reevaluation of the existing monitoring protocols. This study assesses the detection of (possible) anesthesia-related complications within 24 h after IHR in infants under 3 months of age and aims to identify risk factors for these complications. Methods: This retrospective cohort study included consecutive patients aged ≤ 3 months who underwent IHR between November 2015 and August 2023. All underwent IHR under general anesthesia. Subjects were compared based on whether they experienced possible anesthesia-related complications within 24 h after surgery or not. A logistic regression model was constructed and the number needed to monitor was calculated. Results: 306 patients were included, of which 36.3% were prematurely born (gestational age < 37 weeks) and the mean postconceptional age at surgery was 47.7 ± 4.8 weeks. Possible anesthesia-related complications were detected in 10 patients (3.3%), but only 8 (2.6%) were likely attributable to anesthesia. Events included desaturations, convulsions, fever, and a choking incident. Significant differences were found in patients experiencing complications when they had pre-existing respiratory (p = 0.013) or circulatory (p = 0.016) comorbidities. The postconceptional age (PCA) and gestational age (GA) were not significantly different between groups. Univariate logistic regression did not show a significant correlation between anesthesia-related complications and PCA or GA. Conclusions: Our data corroborates the suggestion that prematurity and PCA alone are not the main characteristics upon which postoperative monitoring protocols should be based. We hypothesize that an individualized approach based on comorbidities and clinical history could be more accurate. These findings point toward the necessity of more (prospective) research to support the refinement of postoperative monitoring guidelines to optimize healthcare resource allocation, while maintaining patient safety.