Innovative Techniques and Outcomes in Pediatric and Neonatal Thoracic Surgery: A Comprehensive Narrative Review of Current Practices and Future Directions

Abstract

Pediatric thoracic surgery has undergone significant changes and improvements due to the evolution of minimally invasive techniques, robotic-assisted interventions, and enhanced patient care. Enhanced thoracic surgical interventions progressed in pediatric thoracic tumors, airway management, chest wall reconstruction, and lung transplantation. Key areas for improvement include the adoption of enhanced recovery protocols, enhancing long-term outcomes, and integrating emerging technologies such as 3D printing and artificial intelligence. Despite the advancement in these fields, challenges still exist, underscoring the importance of high and specialized training, multidisciplinary collaboration, and future and continued research to optimize patient outcomes and shape the future of pediatric thoracic surgery. Emerging evidence supports standardized perioperative pathways tailored to children, including multimodal opioid-sparing analgesia, early mobilization, and proactive pulmonary physiotherapy. Advances in imaging and intraoperative navigation are refining lesion localization and resection margins while minimizing collateral trauma. Simulation-based training, competency benchmarks, and international registries can consolidate quality and safety. Equitable access across resource-limited settings, family-centered care, and long-term surveillance for functional, psychosocial, and oncologic outcomes remain priorities. Finally, telemedicine-enabled follow-up and data-driven decision support promise precision and continuity of care.