**10. The future of robotic surgery in children**

Recently, the Senhance Robotics System (Transenterix, Morrisville, NC) has begun offering 3 mm instrument sizes, which could make robotic surgery more technically feasible for even the smallest pediatric patient. Although not currently approved for use in pediatric surgery, the Transenterix platform, was evaluated in an experimental study where surgeons were able to successfully perform intracorporeal and knotted sutures in body cavities as small as 90 ml, and the instruments could be inserted directly without the need for ports, reducing the required distance between ports [5]. This Transenterix platform has haptic feedback.

With advancing technology and the demand for more compact robotic platforms, the future for robotic surgery will doubtlessly result in a reduction of instrument size and an improvement in haptic feedback. This puts the pediatric patient in particular, the newborn at the forefront. Reconstructive surgery such as esophageal and intestinal anastomosis, all of which require a delicate and more magnified approach will benefit enormously from these advances. The pediatric and neonatal patient must be at the forefront of research into the future of robotic surgery [173].

We are at a dawn of a new age in surgery, as we witness the dramatic growth in robotic surgery. The proliferation and commercialization of new robotic surgical systems over the next few years will drive competition, lower cost, and accelerate the adoption of these technologies [174].

Artificial intelligence. More sophisticated systems will track the surgeon's movements and patient data and synchronize with outcomes data to provide us with early warning systems for complications. One more interesting aspect is how these systems will participate in the surgical decision-making process in real time. We are already gathering data on tissue perfusion, helping us decide on the appropriate location for an anastomosis. Additionally, using artificial intelligence, real-time data will be collected from many sources, including electronic medical records, anesthesia monitoring systems, video images, and surgeon data for making decisions that we will increasingly rely on [174].

Digital surgery (Surgery 4.0), the next frontier of surgery, is defined as the convergence of surgical technology, real-time data and artificial intelligence. Following previous waves of disruption, which saw the transition from open (Surgery 1.0) to laparoscopic surgery (Surgery 2.0), and from laparoscopic surgery to robotic surgery (Surgery 3.0), the digital paradigm in surgery is bringing unprecedented changes to the century-old field. The power of linked data and advancements in artificial intelligence are beginning to make a real impact in the way surgeries are performed, reducing well-documented variability in surgical process and outcomes.

Companies, investors, surgeons and health systems are racing to accelerate the digitization of surgery in order to dramatically improve patient outcomes whilst reducing cost and inefficiencies; improve patient access; reduce inequities between populations; improve quality; and deliver more personalized surgical care, and the digital surgery is the next apex in surgery [175].

Verb Surgical is building a digital surgery platform that combines robotics, advanced visualization, advanced instrumentation, data analysis, and connectivity. Surgery 4.0 or digital, which seeks to achieve less invasive and smarter interventions, "marks the beginning of a true democratization of the discipline". The Verb Surgical platform will be an option in the near future of digital surgery [175, 176].
