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HOME > Ann Coloproctol > Volume 42(2); 2026 > Article
Editorial
Minimally invasive surgery
 Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Hanorcid
Annals of Coloproctology 2026;42(2):149-150.
DOI: https://doi.org/10.3393/ac.2026.00486.0069
Published online: April 29, 2026

Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Correspondence to: Jeonghee Han, MD, PhD Department of Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Email: Drhjh81@chamc.co.kr
• Received: April 12, 2026   • Accepted: April 14, 2026

© 2026 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Robot-assisted surgery (RAS) has become a prevalent approach to colorectal cancer surgery, owing to its ability to provide precise visualization and advanced maneuverability [1]. Specifically, the expiration of key patents for the da Vinci Surgical System (Intuitive Surgical) in 2019, which had previously dominated the market, initiated the development of various alternative robotic platforms. In the context of this trend, next-generation robotic models from various countries, such as Japan's hinotori (Medicaroid Corp), are serving as milestones that are shifting the future of colorectal cancer surgery from an era of "monopoly" to one of "diversity."
Recent research findings demonstrate that newly developed robotic platforms can achieve treatment outcomes equivalent to those of the existing "gold standard," the da Vinci Xi [2]. A comparative analysis of right-sided colorectal cancer surgeries revealed that the hinotori system exhibited no statistically significant discrepancy from the da Vinci Xi with regard to blood loss, complication rates (7.4% in both groups), and length of hospital stay (10 days) [3]. Regarding the key indicators that determine the quality of cancer surgery, the number of lymph nodes harvested (25 vs. 29) and the achievement of adequate resection margins, both systems achieved oncologically equivalent outcomes [3]. Although a tendency toward slightly longer operative and console handling times was observed during the early stages of the new platform's introduction, this could be related to the learning curve rather than device performance and did not affect patient safety or surgical accuracy.
A variety of robot platforms have been developed with the primary objective of enhancing surgical precision through their distinct technical strengths. For instance, hinotori utilizes an 8-axis robotic arm to optimize movement flexibility, and its "docking-free" configuration expands the workspace surrounding the access port to mitigate tension on adjacent tissues [4]. Additionally, the ergonomic cockpit design, which is intended to reduce surgeon fatigue, represents a significant innovation [4]. Concurrently, the prevailing da Vinci Xi platform sustains its efficacy through its "table motion" functionality, which facilitates the repositioning of patients during surgical procedures. The latest iteration of this platform incorporates a haptic motion sensor. The Hugo RAS system (Medtronic) offers distinct advantages in terms of ergonomics and workflow by utilizing an open console equipped with a modular arm cart, 3D visualization, and a cloud-based management system [5]. Similarly, the Versius robotic platform (CMR Surgical) aims to reduce surgeon fatigue and improve team communication by revolutionizing the interaction between the surgeon and the console through game-controller-style handles and an open-architecture design [6]. The advent of "customized robotic surgery" in the future will signify a paradigm shift in surgical methodologies. In this new era, surgeons will have the autonomy to select and utilize the most suitable robotic platform based on the patient's anatomical characteristics or the complexity of the procedure.
The advent of a variety of robotic platforms is poised to catalyze market competition and play a pivotal role in the reduction of economic barriers to robotic surgery. The widespread adoption of domestically developed robotic systems in each country will improve cost-effectiveness and increase access to healthcare, enabling a greater number of colorectal cancer patients to benefit from precise robotic surgery. This will contribute to establishing robotic surgery as a global standard for minimally invasive surgery, rather than as the exclusive domain of a few medically advanced nations or large hospitals.
The future of robotic colorectal surgery will not be defined by "competition among devices" but rather by "widespread adoption and optimization of robotic technology." The initial proficiency challenges associated with the implementation of novel systems are anticipated to be fully addressed through subsequent technical training and enhanced familiarity with the systems. Consequently, as larger-scale, multicenter studies and long-term cancer survival data accumulate, surgery using various robotic platforms will firmly establish itself as the new global standard for colorectal cancer treatment.

Conflict of interest

Jeonghee Han is an editorial board member of this journal, but was not involved in the peer reviewer selection, evaluation, or decision process of this article. No other potential conflict of interest relevant to this article was reported.

Funding

None.

  • 1. Milone M, Vertaldi S, Anoldo P, Borin S, Ceccarelli G, D'Amore A, et al. Interim analysis of short-term outcomes between robotic and laparoscopic surgery for colon cancer: results from the ESSIMIC trial. Ann Coloproctol 2026;42:86–93. ArticlePubMedPMCPDF
  • 2. Katsuno H, Morohara K, Endo T, Kikuchi K, Nakamura K, Matsuo K, et al. Propensity score-matched comparison of robot-assisted rectal cancer surgery using hinotori and da Vinci. Ann Coloproctol 2025;41:310–8. ArticlePubMedPMCPDF
  • 3. Morohara K, Katsuno H, Endo T, Nakamura K, Matsuo K, Tsujimura K, et al. Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System. Ann Coloproctol 2026;42:237–46.Article
  • 4. Morohara K, Katsuno H, Endo T, Kikuchi K, Nakamura K, Matsuo K, et al. Short-term surgical outcomes of robot-assisted colectomy for colon cancer using the hinotori Surgical Robot System. Ann Coloproctol 2025;41:97–103. ArticlePubMedPMCPDF
  • 5. Calini G, Cardelli S, Alexa ID, Andreotti F, Giorgini M, Greco NM, et al. colorectal cancer outcomes of robotic surgery using the Hugo™ RAS system: the first worldwide comparative study of robotic surgery and laparoscopy. Cancers (Basel) 2025;17:1164.ArticlePubMedPMC
  • 6. Collins D, Paterson HM, Skipworth RJE, Speake D. Implementation of the Versius robotic surgical system for colorectal cancer surgery: first clinical experience. Colorectal Dis 2021;23:1233–8. ArticlePubMedPDF

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        Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
        Ann Coloproctol. 2026;42(2):149-150.   Published online April 29, 2026
        DOI: https://doi.org/10.3393/ac.2026.00486.0069
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