Advances in robotic surgery platforms have evolved to expand the capabilities and applications to smaller patients for a greater breadth of indications. The utilization in children's surgery was first adopted by pediatric urologists and has rapidly spread to other subspecialties. In pediatric general surgery, the use of the robot has demonstrated many similar benefits including improved three-dimensional visualization, stability with camera control, human wrist-like control, increased precision and improved operative ergonomics 1, 2, 3. Moreover, robotic surgery, much like traditional laparoscopic surgery, requires smaller incisions compared to open surgery, allowing for improved cosmesis, reductions in opiate medication use, and minimized tissue trauma 1,4.

Although robotic surgery has been used in pediatric cases since 2001 5, the field of pediatric general surgery has been slow to adopt robotic techniques in minimally invasive procedures. However, the benefits of robotic surgery can be particularly useful in the pediatric population, where procedures tend to have confined space and operative precision is paramount given the intricate anatomy. Early adopters have posited that robotic surgical techniques are safe, feasible, and have comparable, if not better, outcomes to laparoscopic and open techniques, specifically in the pediatric population 6. Given the benefits to both surgeons and patients, robotic surgery is rapidly spreading across the United States for a variety of pediatric surgical indications, including urologic 7,8, bariatric 9, hernia repair 10, oncologic 11, colorectal 12, and thoracic 13.

Increasing interest in initiating pediatric robotic surgery capabilities is accompanied by many challenges related to scarce availability of new surgical technology. Considerable variability has been anecdotally described regarding successful implementation of robotic surgical techniques between different pediatric surgery practice structures. Therefore, we detail a framework for developing a robotic surgery program in various pediatric general surgery practices, including a collaborative model for a children's hospital in a large medical center associated with an adult hospital, a free-standing children's hospital model, and a community practice model.