The advancement of technology in surgical science permitted the development of minimally invasive surgery (MIS), which allows patients to avoid the negative aspects of traditional “open” surgery. Surgeons and engineers worked in tandem to develop smaller and improved MIS instruments, leading to its application in children years after its introduction in adult surgery. While many advancements have been made, there remain limitations to pediatric MIS due to factors such as smaller operative fields and physiologic constraints. In addition to the creation of an MIS platform, other innovations aid with pain control after open surgery, planning operations using 3D printing, performing fetal surgery to prevent problems before they occur, and even methods to avoid surgery altogether. The unmet clinical needs in children and infants have fostered the development of new technologies and innovations which will allow an endless stream of possibilities to offer our pediatric patients.