Beyond robotic platforms: artificial intelligence and the emergence of intelligent surgical ecosystems in colorectal...

Robotic surgery has substantially advanced minimally invasive colorectal surgery through improvements in dexterity, visualization, and ergonomics. However, contemporary robotic platforms remain fundamentally mechanical systems that rely almost entirely on surgeons for perception, clinical judgment, and intraoperative decision-making. As colorectal surgery becomes increasingly complex and the surgical population grows older and frailer, further progress is unlikely to depend on hardware innovation alone. This narrative review and conceptual synthesis was informed by a purposive, non-systematic search of PubMed, Embase, and Scopus for literature relevant to artificial intelligence (AI) and robotic colorectal surgery. The review focuses on the evolution of robotic platforms, current and emerging AI applications across the colorectal surgical pathway, and the proposed conceptual framework of the Intelligent Surgical Ecosystem. Recent advances in computer vision, foundation models, multimodal AI, and surgical data science are creating opportunities to integrate heterogeneous clinical information to support patient selection, operative planning, context-aware intraoperative assistance, and postoperative management. However, the clinical maturity of these applications varies substantially, with many technologies remaining at developmental or proof-of-concept stages. The convergence of robotics, AI, and digital health technologies provides the conceptual foundation for Intelligent Surgical Ecosystems, in which multimodal data may ultimately be integrated across the perioperative continuum to support precision and patient-centered colorectal surgical care. The future of colorectal surgery lies not in autonomous machines, but in intelligent systems that integrate multimodal data and support governed learning across the surgical pathway to augment human expertise and enable safer, more personalized, and precision-based surgical care.