Pediatric Robotic Surgery in the Philippines: Initial Experience and Early Outcomes

Background: Pediatric robotic surgery has expanded globally but remains under-reported in low- and middle-income countries. We report the first Philippine series of pediatric robotic-assisted general surgery, describing early program implementation and 30-day outcomes in a public tertiary referral center. Methods: A retrospective descriptive case series was conducted of pediatric patients (less than 19 years-old) who underwent robotic-assisted surgery between September 2024 and October 2025. Demographic characteristics, operative metrics (docking time, console time, total operative time, and estimated blood loss), as well as short-term postoperative outcomes, were summarized descriptively. Results: Nine pediatric robotic procedures were performed using the da Vinci platform: four choledochal cyst excisions with hepaticoduodenostomy, two robotic-assisted anorectal pull-throughs for anorectal malformation, two total proctocolectomies (ulcerative colitis; familial adenomatous polyposis), and one ovarian oophorocystectomy. Age ranged from 2–16 years; the lowest weight was 12.7 kg. Median docking, console, and total operative times were 26 (10–45), 195 (70–480), and 272 (145–610) minutes, respectively. Median estimated blood loss was 60 (10–150) mL. There were no unplanned conversions or intraoperative complications. One postoperative complication occurred (chylous leak, Clavien–Dindo II) managed conservatively. No Clavien–Dindo ≥ III complications, mortality, or unplanned ICU admissions occurred; all patients completed 30-day follow-up. Conclusion: Pediatric robotic surgery was feasible with acceptable 30-day outcomes during early implementation in a resource-constrained public healthcare setting. Operative metrics and morbidity were within ranges reported in published pediatric robotic series. Continued case accrual and longer follow-up are required to evaluate functional outcomes, cost implications, and long-term program sustainability.