The Role of Perioperative Artificial Intelligence in Colon and Rectal Surgery

Artificial intelligence (AI) is rapidly transforming surgical practice with growing applications in colon and rectal surgery. This review explores perioperative AI tools that assist with operative planning, intraoperative guidance, and outcome optimization. Preoperative innovations include machine learning models that outperform traditional risk calculators for predicting complications and readmissions, as well as computer vision and radiomics for analyzing imaging in colorectal cancer and inflammatory bowel disease. The integration of molecular and multiomics data further enhances personalized, precision surgical planning. Intraoperatively, deep learning enables computational identification of critical anatomy, including vascular structures, ureters, and pelvic nerves, and supports the objective analysis of advanced imaging techniques such as indocyanine green fluorescence. In terms of surgical techniques, AI-driven video analysis facilitates surgical phase recognition and automated skill assessment, whereas emerging vision-language models and surgical foundation models promise improved documentation and context-aware guidance. Future directions include generative AI for simulation, AI-based coaching, and progress toward autonomous surgical robotics. Although research remains in the early stages and is not yet ready for widespread clinical implementation, ongoing work within the field of colorectal surgery underscores the potential of AI to augment decision-making and standardize surgical care.