Minimally invasive surgery (MIS) is increasingly used for pediatric solid tumors and metastatic disease. Overall improvement of the disruption to both family life and chemotherapy schedules can be achieved by MIS through reduction of peri-operative morbidity with smaller less painful incisions, by limiting surgical site infections, and by optimizing hospital stay duration. Concerns arise about the potential for tumor disruption and seeding during MIS which may upstage the tumor and difficulty in having both proximal and distal vascular control for invasive tumors. MIS plays an increasing role in the management of small or difficult lesions in pediatric oncology.