Introduction:
Nephrectomy is a cornerstone of paediatric urologic surgery for benign renal disease. Minimally invasive surgery (MIS) – procedures such as transperitoneal/retroperitoneal laparoscopy, laparoendoscopic single-site surgery (LESS), and robotic platforms – has increasingly challenged open surgery, but in children it carries technical and physiological constraints, especially in infants, due to limited working space and pneumoperitoneum effects. The aim of this paper is to appraise contemporary evidence on the optimal approach to paediatric nephrectomy by comparing open surgery with MIS techniques.

Methods:
This SANRA-guided narrative review involved a search of the PubMed (MEDLINE) and Embase databases for English-language studies (from 1 January 2015 to 15 December 2025). Comparative studies and systematic reviews/meta-analyses on paediatric nephrectomy and nephron-sparing procedures were included; case reports, animal studies and oncologic indications were excluded. Outcomes included operative time, length of stay, perioperative complications and selected resource-use measures (e.g. transfusions or costs).

Results:
Despite heterogeneity in the indications and designs, MIS was consistently associated with shorter lengths of stay and similar overall complication rates versus open surgery. Operative time results were mixed and depended on procedure type, access route, learning curve and platform; robotic and LESS approaches more often entailed longer operative times and higher costs. The benefits of MIS appeared less consistent in very small children and in duplex-system surgery, where ureteral stump morbidity and residual moiety function are key.

Conclusions:
MIS is feasible and generally safe in selected paediatric patients, and it typically shortens hospitalization time. The approach should be individualized, weighing recovery advantages against operative efficiency, technical complexity, and resource implications.