Robot-assisted resection of abdominal lymphatic malformations in children: a novel minimally invasive strategy for complex lesions

Robotic-assisted surgery (RAS) represents a promising emerging alternative to conventional laparoscopic surgery (LAS) for abdominal lymphatic malformations (ALMs). We aimed to evaluate the safety and efficacy of robotic-assisted resection of ALMs in pediatric patients. A retrospective analysis was performed on 134 children with ALMs who underwent surgery from December 2018 to December 2025 at the Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine. Patients were stratified into two groups according to the surgical modality: the robot-assisted surgery (RAS) group (n = 57) and the laparoscopic surgery (LAS) group (n = 77). The RAS group achieved a higher rate of total intracorporeal cyst dissection (33 vs. 13) and intracorporeal intestinal resection with anastomosis (21 vs. 1), whereas the LAS group more commonly used extracorporeal procedures (31 vs. 0; 32 vs. 3), with significant differences in surgical approach distribution (P < 0.001). The total hospitalization cost was significantly higher in the RAS group than in the LAS group [68286 (60183, 72551) yuan vs. 19261 (15651, 23869) yuan, P < 0.001]. Postoperatively, four complications occurred in the RAS group, while seven complications were observed in the LAS group. RAS appears to be a safe and feasible minimally invasive approach for pediatric ALMs. For complex lesions, RAS may offer advantages in intracorporeal dissection, intestinal preservation, and perioperative recovery. It serves as a favorable minimally invasive alternative to open surgery for complex ALMs, though its higher hospitalization cost limits widespread routine clinical application.