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Next-generation robotics in gastrointestinal surgery

Abstract

The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation — robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery — and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.

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Fig. 1: The future digital robotic ecosystem.
Fig. 2: The DIGiTAL framework.

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Acknowledgements

Infrastructure support for this research was provided by the National Institute for Health Research Imperial Biomedical Research Centre.

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J.M.K., S.E.M. and G.M. substantially contributed to discussion of content, wrote the article, and reviewed and edited the manuscript before submission. A.D. substantially contributed to discussion of content and reviewed and edited the manuscript before submission.

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Correspondence to James M. Kinross.

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J.M.K. has been a consultant for Verb Surgical and Ethicon. He has also received research funding from Intuitive Surgical. All other authors declare no competing interests.

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Kinross, J.M., Mason, S.E., Mylonas, G. et al. Next-generation robotics in gastrointestinal surgery. Nat Rev Gastroenterol Hepatol 17, 430–440 (2020). https://doi.org/10.1038/s41575-020-0290-z

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