Abstract Since January 2006, robotic assistance has been used for performing minimal invasive laparo- scopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci Ò Surgical System from Intuitive Surgical Ò , were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive lapa- roscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term out- come. There was no significant difference between the three groups concerning age, body weight and preop- erative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the lapa- roscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analge- sics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastro- esophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postop- erative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include bet- ter visualisation for the surgeon and greater precision in the movements of the instruments used. Keywords Robotic surgery Á Fundoplication Á Children Á da Vinci Ò Surgical System Á Laparoscopy Á Robot Á Paediatric surgery Introduction Gastroesophageal reflux disease is a common disorder in children, and both medical and surgical treatments have shown outstanding results. Whereas proton pump inhibitors are the mainstay of the treatment, laparo- scopic or open surgical fundoplication is an alternative. There is no conclusive comparison between medical therapy and operative fundoplication. At our centre, fundoplication is performed when the medical therapy has reached its limits without satisfactorily relieving the patient’s symptoms or when a spontaneous physi- ological improvement in the patient’s situation can no longer be expected. At our centre, the fundoplication procedure has been changed over the last 15 years from open surgical procedure to laparoscopic surgery and now to robot- assisted laparoscopic surgery. This report compares our first paediatric fundopli- cations using robot assistance, da Vinci Ò Surgical M. Anderberg (&) Á C. C. Kockum Á E. Arnbjo ¨ rnsson Department of Paediatric Surgery, University Hospital, 221 85 Lund, Sweden e-mail: magnus.anderberg@skane.se Pediatr Surg Int (2007) 23:123–127 DOI 10.1007/s00383-006-1817-2 123 ORIGINAL ARTICLE Robotic fundoplication in children Magnus Anderberg Æ Christina Clementson Kockum Æ Einar Arnbjo ¨ rnsson Accepted: 26 September 2006 / Published online: 18 October 2006 Ó Springer-Verlag 2006