Robotic-assisted vs. Laparoscopic Splenectomy in Children: A Systematic Review and Up-to-date Meta-analysis.

Introduction : Robotic splenectomy has emerged as a promising alternative to laparoscopic surgery, offering potential advantages in precision and ergonomics. However, its clinical superiority remains uncertain due to limited and heterogeneous evidence. Methods : We performed a systematic review and meta-analysis following PRISMA guidelines, utilizing PubMed, CINAHL, Web of Science and EMBASE databases to locate studies on robotic splenectomies in children, registered in PROSPERO (CRD420251104285). Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Random-effects models were fitted using restricted maximum likelihood (REML), and confidence intervals were adjusted using either Knapp–Hartung (HKSJ) or modified Knapp–Hartung (mKH) methods. Results : The analysis included 272 pediatric patients from 16 studies between 2003–2025, of which five were included in the meta-analysis. No statistically significant differences were observed between robotic and laparoscopic splenectomy for operative time, intraoperative blood loss, conversion to open surgery, blood transfusions, or complications. However, the direction of effect estimates consistently favored the robotic approach. A statistically significant reduction in hospitalization days (–0.93 days; 95% CI: –1.61 to –0.24; p = 0.01) was found, though this became borderline with HKSJ adjustment (p = 0.06). Intraoperative blood loss showed significance in the primary model (–63.88 mL; 95% CI: –120.38 to –7.38; p = 0.03), but not after mKH correction (p = 0.16). Heterogeneity was substantial-to-extreme for several outcomes and was only partially accounted for by leave-one-out sensitivity analyses. All findings were rated as very low certainty according to the GRADE framework. Conclusions : Robotic-assisted splenectomy in pediatric patients appears to be a safe and effective technique, associated with low intraoperative blood loss, a low rate of conversion to open surgery, and a low incidence of postoperative complications. Although no statistically significant differences were consistently demonstrated, the direction of effect estimates in several outcomes tentatively favored the robotic approach. While some outcomes showed trends favoring the robotic approach, the limited number of studies and low-quality evidence prevent firm conclusions. Well-designed prospective studies are needed to clarify its clinical benefits.