Objective: We present the applications and experiences of robot-assisted laparoscopic and thoracoscopic surgery (RALTS) in pediatric surgery. Materials and Methods: A prospective, observational, and longitudinal study was conducted from March 2015 to March 2018 that involved a non-random sample of a pediatric population that was treated with RALTS. The parameters examined were: gender, age, weight, height, diagnoses, surgical technique, elapsed time of console surgery, estimated bleeding, need for hemotransfusion, complications, surgical conversions, postoperative hospital stay, and follow-up. The Clavien-Dindo classification of complications was used. The surgical system used was the da Vinci model, Si version (Intuitive Surgical, Inc., Sunnyvale, CA. U.S.A), with measures of central tendency. Results: In a 36-months period, 186 RALTS cases were performed, in 147 pediatric patients and an adult; 53.23% were male, and the remaining were female. The average age was 83 months, ranging from 3.5 to 204 months, plus one adult patient of 63 years. The stature was an average of 116.6 cm, with a range of 55–185 cm; the average weight was 26.9 kg, with a range of 5–102 kg; the smallest patient at 3.5 months was 55 cm in stature and weighed 5.5 kg. We performed 41 different surgical techniques, grouped in 4 areas: urological 91, gastrointestinal and hepatobiliary (GI-HB) 84, thoracic 6, and oncological 5. The console surgery time was 137.2 min on average, ranging from 10 to 780 min. Surgeon 1 performed 154 operations (82.8%), and the remainder were performed by Surgeon 2, with a conversion rate of 3.76%. The most commonly performed surgeries were: pyeloplasty, fundoplication, diaphragmatic plication, and removal of benign tumors, by area. Hemotransfusion was performed for 4.83%, and complications occurred in 2.68%. The average postoperative stay was 2.58 days, and the average follow-up was 23.5 months. The results of the 4 areas were analyzed in detail. Conclusion: RALTS is safe and effective in children. An enormous variety of surgeries can be safely performed, including complex hepatobiliary, and thoracic surgery in small children. There are few published prospective series describing RALTS in the pediatric population, and most only describe urological surgery. It is important to offer children the advantages and safety of minimal invasion with robotic assistance; however, this procedure has only been slowly accepted and utilized for children. It is possible to implement a robust program of pediatric robotic surgery where multiple procedures are performed.

Report our experience in the treatment of choledochal cyst with robot-assisted surgery in children and perform a current analysis of both approaches of minimally invasive surgery, for this anomaly. Results:We treated 4 patients with choledochal cyst, relation 1:3 female, the averages was in age 3 years, weight 15 kg and height 94.2 cm. Type 1-A cysts were three and one 1-C, the average size of the cysts, 9.6 cm. Clinically, they presented: abdominal mass 3, jaundice episode 3 and fever 2. The following are average values of: total surgical times 360 min and console surgery time 230 min, bleeding 32.5 ml, and postoperative stay 4.7 days. Conversions, complications and mortality 0%. Follow-up average 29 months, and all patients are asymptomatic. Currently, the number of children with choledochal cyst treated with robotic surgery, barely reaches about 3%, in relation to those treated with conventional laparoscopy. The initial experience was published with laparoscopy in Oct-1995 and with robotic surgery in Apr-2006. Conclusions: Our results are encouraging, and show the advantages of robotic surgery, although our experience is limited to a few cases. Robotic surgery for the treatment of choledochal cyst is feasible and safe. The current results with both minimally invasive approaches are very similar, but we consider that it represents an important bias, the great advantage in the application that conventional laparoscopy takes to robotic surgery. To date, very few pediatric surgeons in the world have applied robotic surgery to the choledochal cyst. Material and Methods:Study observational, prospective, and longitudinal, in pediatric patients with choledochal cyst treated with robotic-assisted surgery, from Jul-2016 to Apr-2019. The diagnosis was made with laboratory studies, USG and cholangioresonance.The surgery performing one part by laparoscopy, the extracorporeal Roux-en-Y, and other part with robotic assistance (cholecystectomy, retrocolic Roux-en-Y, and the hepaticojejunostomy). We use 5 trocars, 4 robotics and a laparoscopic. Registered variables: demographic data, cysts according to Todani's classification, size, clinic, total and robotic surgery time, bleeding, conversions, complications, postoperative stay and follow-up. We carry out a detailed non-systematic review of previous publications on this pathology with conventional laparoscopic and robotic surgery. A choledochal cyst is a rare congenital cystic dilatation of the extra or intrahepatic biliary tract or both. It was first described by Vater and Ezler in 1723 [1].Choledochal cysts have an incidence of 1 in 100,000-150,000 live births in the western population, but reported to be as high as 1 in 13,500 live births in the United States and 1 in 15,000 in Australia. The incidence is higher in Asian population with an incidence of 1 in 1000, of which about two-third cases are reported from Japan. Choledochal cysts are diagnosed in childhood about 75%, also have an unexplained female:male preponderance, commonly reported as 4:1 to 3:1 [2].

On the other hand, the first minimally invasive robot-assisted surgery in children was the fundoplication technique, were carried out by Meininger et al. [10] in July 2000 and reported in