Introduction:
Nephrectomy is a cornerstone of pediatric urologic surgery for benign renal disease. Minimally invasive surgery (MIS)—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. Objective: To appraise contemporary evidence on the optimal approach to pediatric nephrectomy by comparing open surgery with MIS techniques.

Methods:
A SANRA-guided narrative review searched PubMed (MEDLINE) and Embase for English-language studies (Jan 1, 2015–Dec 15, 2025). Comparative studies and systematic reviews/meta-analyses on pediatric nephrectomy and nephron-sparing procedures were included; case reports, animal studies, and oncologic indications were excluded. Outcomes included operative time, length of stay (LOS), perioperative complications, and selected resource-use measures (e.g., transfusion, costs).

Results:
Despite heterogeneity in indications and designs, MIS was consistently associated with shorter LOS 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 showed longer operative times and higher costs. 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 pediatric patients and typically shortens hospitalization. The approach should be individualized, weighing recovery advantages against operative efficiency, technical complexity, and resource implications.