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Contemporary Regional Disparities in Robotic-Assisted Rectal Resection in Japan: A Nationwide Population-Based Study
Ryo Ohta1, Takeshi Yamada2, Key Uehara2
1Department of Gastroenterological Surgery Nippon Medical School Musashikosugi Hospital Kawasaki Japan.
Annals of Gastroenterological Surgery
|July 24, 2026
Summary
Robotic rectal resections grew in Japan post-2018 but show significant regional disparities. Adoption varied by prefecture, with higher robotic use in urban areas, highlighting the need for ongoing monitoring.
Area of Science:
- Surgical innovation and healthcare access
- Health services research
- Minimally invasive surgery adoption
Background:
- Robotic-assisted rectal resection adoption in Japan surged following national health insurance reimbursement in 2018.
- Population-level regional distribution and disparities in robotic rectal resection remain unclear.
- The National Database (NDB) Open Data provides a valuable resource for analyzing these trends.
Purpose of the Study:
- To evaluate temporal trends in robotic-assisted rectal resection in Japan.
- To assess contemporary regional disparities in its adoption and utilization.
- To investigate the association between urbanization and robotic rectal resection rates.
Main Methods:
- Analysis of NDB Open Data from fiscal years 2014-2023, including all rectal resection procedures.
- Classification of procedures into open, laparoscopic, and robotic-assisted categories.
- Calculation of prefecture-level surgical rates and robotic proportions, standardized using claim ratios (SCRs) and analyzed against population density.
Main Results:
- Robotic rectal resections increased significantly post-2018, while open surgery declined.
- Substantial inter-prefectural variation in surgical volume and robotic utilization was observed, persisting after standardization.
- Robotic proportion positively correlated with population density (Spearman ρ=0.338, p=0.020), with urban areas showing higher, though not statistically significant, median robotic use (29.3% vs. 19.0%).
Conclusions:
- Robotic-assisted rectal resection adoption in Japan expanded after reimbursement but exhibits marked inter-prefectural heterogeneity.
- Geographic variations in adoption persist, emphasizing the need for nationwide monitoring.
- Understanding and addressing regional disparities is crucial for equitable access to robotic surgery.
