Robotic-assisted surgery as an enabling technology for ovarian-sparing management in pediatric benign ovarian tumours: a comparative study

Background: Preservation of ovarian function is a major objective in the surgical management of benign ovarian tumours in pediatric and adolescent patients. Robotic-assisted surgery may facilitate ovarian-sparing procedures by improving surgical precision and dissection capabilities. This study aimed to evaluate the feasibility and perioperative safety of robotic-assisted ovarian-sparing surgery and to compare outcomes with a pre-robotic cohort. Methods: A single-centre retrospective comparative cohort study was conducted at a tertiary pediatric referral centre. Consecutive patients aged ≤18 years undergoing surgery for radiologically suspected benign ovarian tumours between January 2023 and December 2025 were included. Patients were divided into a pre-robotic cohort (2023-2024) and a robotic cohort (2025). The primary outcome was the rate of ovarian-sparing surgery. Secondary outcomes included conversion to open surgery, operative time, length of hospital stay (LOS), postoperative complications, reoperation, and postoperative analgesic consumption. Results: Twenty-four patients were included: 14 in the pre-robotic cohort and 10 in the robotic cohort. Baseline demographic characteristics were comparable between groups. Ovarian-sparing surgery was achieved in all robotic cases (100%) compared with 85.7% in the pre-robotic cohort. No conversions to open surgery occurred in the robotic group, whereas two conversions/oophorectomies occurred in the pre-robotic cohort. Operative time was longer in the robotic cohort (median 2:27:30 vs. 1:42:00; p=0.021), while LOS remained comparable. No intraoperative complications or surgical site infections were observed. One robotic patient required reoperation for trocar-site bleeding. Opioid rescue therapy was significantly less frequent in the robotic cohort (10% vs. 50%; p=0.048). Conclusions: Robotic-assisted ovarian-sparing surgery for benign ovarian tumours in pediatric and adolescent patients is feasible and safe. Robotic technology may facilitate fertility-preserving surgery by supporting precise tumour enucleation and consistent preservation of healthy ovarian tissue, particularly in technically demanding cases.