Collection
Pediatric Surgery Essentials
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Congenital Anomalies
1 item
Gastrointestinal1 item
Common Surgical Conditions
1 item
Inguinal Hernia1 item
Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
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Kathleen Heller, Brielle V Ochoa, Stephanie F Brierley, Benjamin E Padilla; Pediatric Inguinal Hernia Collaborative Group; Amir Alhajjat, Emily Byrd, Stephanie D Chao, Christopher Clinker, Jose Diaz-Miron, Goeto Dantes, R Scott Eldredge, El
video0:54 · Feb 2026
Surgical Techniques & Technology
2 items
Robotic Surgery2 items
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
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This video series recaps highlights from the 13th Annual Pediatric Surgery Update Course. Dr. Juan Gurria discusses the pros and cons of robotic surgery in pediatric patients, comparing it to laparoscopic surgery, and exploring its future.
video4:35 · Jun 2026
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
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This video series recaps highlights from the 13th Annual Pediatric Surgery Update Course. Dr.
podcast · Oct 2026
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Recent multi-institutional data demonstrate that surgeon volume significantly impacts outcomes in pediatric inguinal hernia repair, with low-volume surgeons showing 1.5-fold higher recurrence rates overall. This volume effect is technique-specific: open repairs show no volume-related difference in recurrence, while laparoscopic repairs by low-volume surgeons carry a 3.3-fold increased recurrence risk. Maintaining adequate case volume for each approach separately—or consulting higher-volume colleagues—is recommended.
Robotic platforms are expanding in pediatric surgery, with applications in thoracic, pelvic, abdominal tumor, and urologic cases. Compared to laparoscopy, robotics offer enhanced depth perception, reduced surgeon fatigue, and a shorter learning curve (10-15 vs 20-30 cases for basic proficiency). In colorectal surgery, robotic approaches demonstrate lower conversion rates to open despite longer operative times, with oncologic outcomes comparable to laparoscopy. Barriers include cost, setup time, port size constraints, and lack of FDA pediatric approval. Select indications such as adrenal masses, ovarian cysts, and nephrectomies show particular benefit.
- Laparoscopic inguinal hernia repairs by low-volume surgeons have 3.3-fold higher recurrence; volume thresholds matter by technique, not globally.
- Robotic surgery requires half the cases for proficiency versus laparoscopy (10-15 vs 20-30), with lower conversion rates in colorectal cases.
- Robotics provide superior depth perception and reduced surgeon fatigue but face barriers of cost, setup time, and lack of FDA pediatric approval.
- Oncologic outcomes are equivalent between robotic and laparoscopic approaches in pediatric colorectal surgery despite longer robotic operative times.
- Ideal robotic indications in pediatrics include adrenal masses, ovarian cysts, nephrectomies, and pelvic reconstruction with 3cm port spacing in small patients.
For patients & families
Pediatric surgeons are exploring how their experience and the tools they use affect outcomes for children. A large study found that when surgeons perform fewer hernia repairs each year, children have a higher chance of the hernia coming back—about 1.5 times more likely overall . This difference was especially clear for repairs done with a camera and small instruments (laparoscopic approach), where less-experienced surgeons saw more than three times the recurrence rate . For traditional open repairs, surgeon experience didn't seem to matter as much . The study authors suggest that surgeons who don't do many laparoscopic hernia repairs should consider working with colleagues who do more of them . Meanwhile, robotic surgery—where the surgeon controls robotic arms from a console—is becoming more common in children's hospitals [e12230-c1, e12230-c20]. Doctors report that it offers better views and more precise movements than traditional laparoscopic tools [e12230-c2, e12230-c9], and surgeons may become skilled more quickly, needing only 10 to 15 cases versus 20 to 30 for laparoscopy [e12230-c17, e12230-c16]. Children may recover faster with less pain , though the technology is still being studied and costs remain a concern .
Pediatric surgeons are exploring how their experience and the tools they use affect outcomes for children. A large study found that when surgeons perform fewer hernia repairs each year, children have a higher chance of the hernia coming back—about 1.5 times more likely overall . This difference was especially clear for repairs done with a camera and small instruments (laparoscopic approach), where less-experienced surgeons saw more than three times the recurrence rate . For traditional open repairs, surgeon experience didn't seem to matter as much . The study authors suggest that surgeons who don't do many laparoscopic hernia repairs should consider working with colleagues who do more of them . Meanwhile, robotic surgery—where the surgeon controls robotic arms from a console—is becoming more common in children's hospitals [e12230-c1, e12230-c20]. Doctors report that it offers better views and more precise movements than traditional laparoscopic tools [e12230-c2, e12230-c9], and surgeons may become skilled more quickly, needing only 10 to 15 cases versus 20 to 30 for laparoscopy [e12230-c17, e12230-c16]. Children may recover faster with less pain , though the technology is still being studied and costs remain a concern .
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Surgeon annual volume impacts recurrence rates of pediatric inguinal hernia repairs: A multi-institutional study
Heller et al. published a multi-institutional study in the Journal of Pediatric Surgery in 2025 exploring the impact of surgeon volume on patients with inguinal hernias.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:10 ↗
Inguinal hernias repaired by lower volume surgeons had a 1.5 fold increase in the odds of recurrence.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:22 ↗
When broken down by surgical approach, there was no difference in recurrence rates for open inguinal hernia repairs based on surgeon volume.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:30 ↗
Laparoscopic inguinal hernia repairs done by lower volume surgeons had a 3.3 fold increase in the odds of recurrence.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:35 ↗
The authors of the Heller et al. study recommend maintaining a high volume of laparoscopic repairs, and if that's not possible, to seek help from a higher volume surgeon.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:44 ↗
Update Course Rewind 2025: Robotics in Pediatric Surgery: Which indications benefit the most?
All pediatric surgical patients are good candidates for robotic surgery.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position0:33 ↗
Robotic surgery provides 7 degrees of freedom for mobility compared to the human hand's 6 degrees.
clinicalJuan Gurria0:41 ↗
Robotic surgery reduces postoperative pain and infection risk, leading to faster recovery.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position1:02 ↗
The learning curve for robotic surgery is better than laparoscopic surgery.
clinicalJuan Gurria1:21 ↗
Time to reduce operative times is way faster for robotic surgery than laparoscopic after a few cases.
clinicalJuan Gurria1:26 ↗
There is no FDA approval for robotic surgery in pediatrics, but it should be coming soon.
guidelineJuan Gurria1:42 ↗
After a few cases, robotic surgery decreases operative time, which reduces costs in the long run.
clinicalJuan Gurria1:53 ↗
New robotic systems allow surgeons to detect when suture is about to rupture.
clinicalJuan Gurria2:05 ↗
Robotic surgery improves depth perception compared to laparoscopic surgery.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:09 ↗
Robotic surgery reduces surgeon fatigue compared to laparoscopic surgery.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:14 ↗
Surgeons get tactile feedback from visual cues in robotic surgery, and it takes only a few cases to adapt.
clinicalJuan Gurria2:17 ↗
In colorectal surgery, robotic operative time is longer than laparoscopic.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:23 ↗
Laparoscopy has a higher conversion rate to open surgery than robotic surgery in colorectal cases.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:23 ↗
Both robotic and laparoscopic surgery have comparable oncologic results.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:32 ↗
With trained personnel, room turnover time for robotic surgery equals that of laparoscopic surgery.
clinicalJuan Gurria2:37 ↗
Basic proficiency in laparoscopy requires 20 to 30 cases.
clinicalJuan Gurria2:51 ↗
Basic proficiency in robotic surgery requires 10 to 15 cases.
clinicalJuan Gurria2:55 ↗
It takes half the number of cases to become proficient in robotic surgery versus laparoscopy.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position2:57 ↗
Robotic surgery does not impair outcomes in oncologic surgeries.
clinicalJuan Gurria3:07 ↗
Robotics can be indicated for surgeries in the chest, pelvic reconstruction, abdominal tumors, and urology.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position3:14 ↗
In smaller patients, ports should be measured 3 centimeters apart.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position3:24 ↗
Future pediatric surgeons entering the field will be doing robotic surgery rather than laparoscopy.
opinion3:28 ↗
Robotic surgery in pediatric patients is ideal in select cases including adrenal masses, polyoco cysts, and nephrectomies.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position3:38 ↗
Reported cons of robotic surgery include cost, setup time, the size of the ports, and a steep learning curve.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position3:52 ↗
Once proficiency is achieved, operative times and conversions to open surgery are lower for robotic surgery compared to laparoscopy.
Host summaryJill Knepprath summarizing the discussion — not the host's own clinical position4:06 ↗
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