Integrated robotics, AI and 3D printing for precision and personalized upper gastrointestinal surgery: a narrative review

Introduction

Upper gastrointestinal (GI) surgery is undergoing a remarkable transformation with the integration of robotics, artificial intelligence (AI), and three-dimensional (3D) printing. This narrative review explores their role in personalized surgical care, with emphasis on advantages, limitations, potential complications, and key technical considerations. By examining current applications and future directions, we aim to highlight how these technologies influence precision, safety, and patient-centered outcomes (1-5).

Personalization in upper GI surgery extends beyond disease treatment to encompass the patient as a whole. The integration of robotics, AI, and 3D printing within patient-centered care aims not only to improve clinical outcomes but also to ensure recovery experiences that reflect individual needs and values. This framing provides the foundation for the technologies discussed in this review.

Robotic-assisted surgical techniques have become central to this progress, offering unmatched precision, dexterity, and visualization. These platforms elevate minimally invasive procedures such as esophagectomy and gastrectomy, enabling surgeons to perform controlled dissections and reconstructions in anatomically demanding regions while reducing postoperative complications (2,4,6,7).

AI occupies an indispensable role in augmenting these advancements by significantly enhancing decision-making processes at every critical stage of the patient care continuum. From the intricate aspects of preoperative planning to the dynamic requirements of intraoperative guidance and the essential elements of postoperative monitoring, sophisticated AI algorithms meticulously analyze vast datasets in order to identify meaningful patterns, predict potential outcomes, and propose tailored interventions that are specifically designed for individual patient circumstances. Machine learning (ML) models are already demonstrating their potential by improving the detection of cancers, evaluating surgical risks, and optimizing workflows within the healthcare system, ultimately contributing to a more proactive and efficient approach to patient care (8-10).

Simultaneously, the advent of 3D printing technology is setting in motion a profound revolution in the realms of surgical preparation and training methodologies. By producing detailed and patient-specific anatomical models, surgeons are afforded the invaluable opportunity to rehearse complicated surgical procedures and refine their technical competencies prior to entering the operating room environment. Lastly, this revolutionary technology supports the manufacturing of customized implants and prosthetics that are intricately designed to align with each patient’s distinctive anatomical profile, thereby refining the precision of surgical interventions and enhancing recovery effectiveness (11-14).

The intersection of robotics, AI, and 3D printing technologies signifies not just a technological progression. Instead, it marks a pivotal shift in paradigm that aligns closely with the essential aims of modern medicine, which encompass precision, personalization, and the improvement of patient care quality. With the evolution of these complex technologies and their deeper integration into clinical processes, they are set to not only modify surgical practices but also to innovate the global structure of healthcare distribution (15,16). This review examines their current applications, associated challenges, and future potential in upper GI surgery, with the aim of defining their role in advancing patient-centered surgical care. Unlike previous reviews that have examined robotics, AI, or 3D printing in isolation or across general surgical practice, this review is distinctive in synthesizing their combined impact within upper GI surgery, offering an integrated perspective that underscores both their convergence and their implications for personalized medicine. We present this article in accordance with the Narrative Review reporting checklist (available at https://ales.amegroups.com/article/view/10.21037/ales-25-23/rc).

Methods

This narrative review was conducted to provide a comprehensive synthesis of current advances integrating robotics, AI, and 3D printing in upper GI surgery. A systematic literature search was performed in PubMed, Embase, and Scopus to identify relevant English-language publications from database inception through September 09, 2025. The search strategy combined both Medical Subject Headings (MeSH) and free-text terms including “robotic surgery”, “artificial intelligence”, “machine learning”, “deep learning”, “3D printing”, “personalized surgery”, “precision surgery”, and “upper GI surgery”. Additional records were identified through manual screening of the reference lists of key articles and reviews to ensure inclusion of the most influential and contemporary work. A summary of the search process and parameters is presented in Table 1.

Eligible studies comprised randomized and nonrandomized clinical trials (RCTs), comparative cohort studies, case series, meta-analyses, systematic and narrative reviews, and technical reports involving adult populations. Only articles published in English were included. Exclusion criteria encompassed preprints, conference abstracts without full text, animal-only studies, and case reports unrelated to upper GI procedures or surgical innovation. The primary focus of selection was on publications addressing clinical outcomes, workflow efficiency, oncologic safety, ergonomics, cost-effectiveness, and training implications related to robotic, AI-assisted, or 3D-guided surgery.

The selection and verification of articles were conducted independently by the first author and cross-checked by the co-author. Given the expected heterogeneity in study designs and outcome measures, data were analyzed qualitatively. Quantitative synthesis was not performed, as the objective of this review was to provide an interpretative and critical overview of the evolving role of technology in upper GI surgery rather than a meta-analytic summary.

The transformation of upper GI surgery

The role of technology in modernizing surgical practices

Technology has fundamentally transformed almost every dimension of human existence, and its influence on surgical practices is remarkably profound. In the domain of upper GI surgery, where precision and careful planning are critical, the advent of sophisticated instruments such as robotic systems, AI, and 3D printing technologies has opened doors to entirely new possibilities. These advancements have fundamentally altered not only how surgeons operate but also their conceptualization of patient care (17-19).

At its essence, the practice of surgery has persistently focused on bettering quality of life. However, it is also a discipline that necessitates exceptional precision and expertise, particularly within the complex structures of the upper GI tract. Even minor errors can lead to significant repercussions, such as anastomotic leaks, strictures, or inadvertent injury to adjacent structures. These complications often prolong hospitalization, increase the risk of re-admission, and can impair long-term quality of life through difficulties in swallowing, chronic pain, or nutritional deficiencies. In the case of malignancy, such adverse events may also delay the initiation of adjuvant therapy, thereby impacting overall survival (OS) outcomes (20,21).

This underscores the transformative nature of technology, which empowers surgeons to attain levels of accuracy and control previously deemed unattainable, both in the delicate physical handling of tissues and in the structured coordination of each procedural step. This dual capacity ensures that dissections, suturing, and reconstructions are carried out with greater stability, while the overall flow of the operation proceeds in a more deliberate and predictable manner (20,22).

Robotic surgical systems, for example, serve as an advanced adjunct that extends a surgeon’s existing skills, allowing them to apply their expertise with greater precision and consistency. Rather than replacing surgical ability, the robotic platform enhances visualization, dexterity, and stability, thereby enabling surgeons to perform complex maneuvers more effectively within confined anatomical spaces. Utilizing robotic instruments allows for procedures to be conducted through small, minimally invasive incisions, which reduce postoperative discomfort, accelerate recovery, and diminish complication rates for patients (21,22).

While these benefits are also observed with conventional laparoscopy, the robotic platform confers additional, unique advantages. These include wristed instruments that provide a greater range of motion than the rigid tools of laparoscopy (23), tremor filtration that stabilizes delicate maneuvers (24,25), and 3D, high-definition (HD) visualization that enhances depth perception (25,26). Collectively, these features enable surgeons to perform complex tasks, such as precise suturing, meticulous dissection, and lymphadenectomy in confined anatomical spaces, with a level of stability and dexterity that extends beyond the capabilities of standard laparoscopy. Operations that once required large incisions, such as esophagectomies or gastrectomies, can now be undertaken using a minimally invasive robotic approach. Although current evidence indicates that robotic resections may require operative times comparable to, or even longer than, open procedures, the platform provides superior visualization, refined precision, and reduced perioperative morbidity. These elements translate into greater procedural efficacy, demonstrated through more accurate dissections and lower intraoperative blood loss, for example, in gastric cancer, a meta-analysis of 16 studies found a mean difference (MD) of −15.9 mL favoring robotic over laparoscopic gastrectomy (LG) (95% CI: −23.35 to −8.39; P<0.0001), and in esophagectomy, cohort data report mean bleeding of 100 mL with robotic-assisted minimally invasive esophagectomy (RAMIE) versus 120 mL with conventional minimally invasive esophagectomy (c-MIE) (P=0.006) (27,28). At the same time, the enhanced stability and control of the robotic system offer assurance to the operating surgeon, fostering confidence during technically demanding maneuvers and ultimately supporting safer and higher-quality outcomes for patients (20-22,29).

AI adds another dimension to the modernization of upper GI surgery by directly supporting disease-specific decision-making. In esophagectomy, AI-enhanced imaging has improved the detection of early esophageal neoplasia and guided more precise margin assessment during minimally invasive resections (30,31). Similarly, predictive models trained on perioperative data have been used to stratify the risk of anastomotic leakage and pulmonary complications, two of the most serious concerns in upper GI operations (32). In gastrectomy for gastric cancer, AI-based approaches combined with robotic platforms have improved resection accuracy and lymph node assessment, supporting oncologic safety while preserving healthy tissue (33). Collectively, these examples highlight how AI applications are beginning to directly influence perioperative planning and intraoperative decision-making in upper GI surgery (31).

Moreover, 3D printing has revolutionized the preparatory phase of surgery into a concrete and interactive process. This innovative technology enables surgeons to fabricate intricate, patient-specific models of anatomical structures (34,35). Envision the ability to physically manipulate a 3D representation of a patient’s tumor prior to entering the surgical theater. Such capability allows for meticulous planning of each procedural step with heightened confidence. In addition to preparatory advancements, 3D printing has enabled the development of customized implants and prosthetics specifically designed to accommodate the distinctive anatomy of each patient, thereby improving surgical outcomes and recovery pathways (36).

What is particularly inspiring is the synergistic interaction among these technologies. Robotics deliver physical precision, AI contributes cognitive capabilities, and 3D printing ensures customization (37,38). Collectively, they are altering the realm of upper GI surgery. This evolution is not merely about enhancing surgical efficiency. It is fundamentally about enriching the patient’s journey from diagnosis through recovery.

As these technologies progress, their capacity to innovate surgical methodologies is boundless. They are not only enhancing the safety and potency of procedures but also expanding the horizons of surgical possibilities. Ultimately, the objective remains singular: to provide every patient with optimal care, supported by tools that make this aspiration increasingly attainable.

Precision and personalization: a new standard in patient care

The field of modern medicine is evolving towards a care paradigm that is more and more adapted to the specific characteristics inherent to the patients involved. This situation is especially observable within the scope of GI surgery (39,40), where adjusting treatment based on the specific patient can greatly impact clinical results. The concepts of precision and personalization have transitioned from being merely aspirational goals to becoming integral components of surgical practice, propelled by technological innovations that facilitate bespoke strategies for each patient (41-43).

Precision in upper GI surgery is predicated upon a comprehensive understanding of the specific intricacies associated with each clinical scenario. Surgeons encounter patients with diverse anatomical configurations, medical histories, and surgical requirements. In response to this variability, cutting-edge technologies furnish practitioners with tools that empower them to manage these disparities with exceptional attention to detail. For example, preoperative imaging modalities, augmented by AI, provide intricate insights into the unique anatomical and pathological conditions of each patient (32,44). Through the consolidation of this information, surgeons can establish a surgical framework that diminishes possible threats while maximizing the chances of advantageous outcomes.

The concept of personalization is inherently linked to precision in surgical practice. The trajectory of each patient’s care necessitates decisions that resonate with their individual needs, preferences, and lifestyle considerations. Presently, this is achievable through advancements such as customized implants and patient-specific surgical guides, which ensure that surgical interventions are tailored to the individual rather than conforming to a standardized model (45,46). To illustrate, employing 3D printing technology allows surgeons to create solutions that align perfectly with the unique dimensions and forms of a patient’s body, enhancing comfort, utility, and healing effects (47).

This progression towards individualized care transcends the borders of the surgical world. Precision-oriented technologies, including predictive algorithms, are increasingly applied to anticipate a patient’s postoperative requirements, such as rehabilitation therapies or specialized monitoring protocols, thereby supporting a recovery process that is as seamless and efficacious as the surgical intervention itself. It should be emphasized, however, that these tools cannot foresee every intraoperative challenge or technical setback. Their role is to enhance clinical decision-making and facilitate personalized care, while the surgeon’s expertise and technical ability remain central to achieving safe and effective outcomes. By identifying patterns that may signal postoperative complications or the need for specific adjustments, these technologies allow healthcare teams to plan ahead and deliver care that is not only accurate but also considerate and patient-centered (48).

From a technical standpoint, contemporary robotic platforms pair a surgeon console with a multi-arm patient cart and 3D HD vision. Core features include 7-degree-of-freedom, wristed instruments (for intracorporeal suturing and lymphadenectomy), motion scaling, and tremor filtration, which together improve fine motor control in confined upper-GI spaces. Adjunct capabilities such as stable camera control, dual-console training, and fluorescence imaging (near-infrared indocyanine-green) support real-time assessment of tissue perfusion and lymphatic mapping during esophagectomy and gastrectomy. Ergonomic benefits (seated posture, neutral wrist/shoulder positions) reduce fatigue in long cases and may help maintain performance (24,49-53).

What makes this approach truly transformative is its ability to bridge the gap between technical excellence and human connection (54). Precision and personalization are not just about making procedures more efficient. They are about creating a sense of trust and partnership between the surgeon and the patient. When a patient feels that their treatment plan has been designed just for them, it fosters confidence and a greater sense of involvement in their care (55).

Data-driven tools, particularly predictive models, are increasingly used to anticipate postoperative requirements such as rehabilitation or specialized monitoring. These systems aim to streamline recovery, lower the risk of readmission, and guide perioperative planning in a patient-specific way. They cannot account for every intraoperative complication or technical setback. Their function is to enhance clinical decision-making, while safe outcomes still depend on surgical expertise.

Robotics and the evolution of precision surgery

Redefining precision in upper GI surgeries

The integration of robotic systems has redefined precision in upper GI surgery by overcoming the limits of manual dexterity and two-dimensional (2D) imaging (24). Multi-degree articulation and 3D visualization enable accurate dissection and reconstruction while reducing tissue trauma and supporting both functional and oncologic outcomes (56,57). With advances in technology, surgeons are now better equipped to manage technically demanding procedures. The robotic platform contributes by offering stability and precision in confined anatomical regions, but it remains a tool whose benefits depend on the surgeon’s own judgment and experience. This convergence of human insight and robotic precision epitomizes a broader shift towards a more sophisticated, personalized standard in upper GI surgery, promising improved outcomes and a reduction in perioperative complications (58).

For example, van Boxel et al. demonstrated that RAMIE led to reduced postoperative morbidity and improved lymph node dissection quality compared to c-MIE, reinforcing the advantages of robotic technology in esophageal surgery (56).

The role of robotics in complex procedures

In the field of advanced upper GI interventions, the introduction of robotics has become a vital component, adeptly addressing the various challenges these operations present. Modern robotic instruments, featuring flexible, articulated arms that mimic the finesse of a human hand while neutralizing natural tremors, allow clinicians to perform intricate maneuvers within confined anatomical spaces. This technological breakthrough is especially beneficial when navigating the dense networks of blood vessels, nerves, and connective tissues typical of the upper digestive tract. The high-resolution, 3D views provided by these systems facilitate a clear understanding of tissue layers, enabling the surgeon to differentiate healthy from affected areas with remarkable clarity (49). For instance, a study by Talamini et al. in Surgical Endoscopy evaluated 211 robotic surgical procedures and concluded that robotic assistance provided improved visualization and dexterity, facilitating precise dissections in confined spaces. This enhancement contributed to reduced intraoperative complications (50).

Furthermore, robotic technology combines stable control with HD visualization, enabling methodical, adaptive maneuvers that protect vital structures and convert complex, high-risk procedures into safer, more effective operations (51).

An added advantage is the educational value of robotic systems, which offer a unique learning opportunity for trainees and experienced surgeons alike. While recording of procedures is also possible in conventional laparoscopy, robotic systems facilitate a more immersive review by combining HD 3D visualization with precise instrument tracking, thereby enriching both technical assessment and training. This broader shift in practice emphasizes meticulous planning, refined execution, and the advantages in precision, flexibility, and outcomes outlined in Table 2 (24,27,33,49,50,59-64).

Real-life success: robotic-assisted esophagectomy

Robotic-assisted esophagectomy stands as a prime example of how cutting-edge technology can redefine surgical practice, particularly in the realm of upper GI interventions. In the past, the removal of the esophagus was one of the most challenging procedures due to the densely packed structures within the chest and neck, including crucial nerves, major blood vessels, and the airway. The advent of robotic systems has revolutionized this procedure by allowing surgeons to perform extremely delicate dissections with heightened control and confidence (65).

In practice, these robotic platforms provide surgeons with unparalleled visual clarity and steady instrument guidance, which are essential when working in narrow and sensitive anatomical regions. The precise articulation and stable support offered by these systems have been linked to lower risk of key complications: robotic gastrectomy (RG) shows significantly fewer conversions to open surgery [odds ratio (OR) =0.62; P=0.004], and overall postoperative complications (OR =0.82; P<0.001) compared to LG (64,66). In RAMIE, the incidence of left recurrent laryngeal nerve palsy was substantially lower than with c-MIE (0% vs. 9%, P=0.022) in the full cohort, and likewise 0% vs. 10% (P=0.022) after propensity matching (66).

These benefits are reflected in clinical outcomes. For operative time, results vary by program and experience. A randomized controlled trial reported RAMIE to be ~41 minutes faster than c-MIE (204 vs. 245 minutes; P<0.001) (67), with similar findings summarized in contemporary reviews (68). Large learning-curve series show that operative times decrease as programs mature; for example, in a 500-case RAMIE learning-curve analysis, the mean total time decreased from approximately 420 minutes in the initial phase to approximately 373 minutes once more than 150 cases had been completed (69). Postoperative recovery is at least comparable, and single-center series report earlier mobilization/less intensive postoperative care after RAMIE (70). The success of robotic-assisted esophagectomy is not merely about technical achievement; it also represents a meaningful improvement in the overall patient experience. Patients report less pain, quicker recovery, and a more optimistic outlook on their treatment process, which underscores the holistic impact of integrating advanced robotics into surgical practice (71).

Further support for these outcomes comes from a comprehensive study, which evaluated the long-term outcomes of robot-assisted Ivor Lewis (RAIL) esophagectomy in 112 patients, predominantly with esophageal adenocarcinoma. The findings demonstrated comparable long-term OS and disease-free survival (DFS) to non-robotic esophagectomies, with 5-year OS at 49.4% for cancer patients and manageable postoperative complications, supporting the efficacy and safety of RAIL in esophageal cancer treatment (57).

Beyond immediate outcomes, the long-term benefits of robotic-assisted esophagectomy are increasingly evident. Studies have demonstrated not only comparable survival rates but also improvements in patient-reported quality of life, particularly in domains such as swallowing function, nutritional status, and the ability to resume normal daily activities (57,70). Taken together, these results indicate that robotic technology can support both short-term safety and long-term well-being in patients undergoing esophagectomy. This surgical evolution, marked by a confluence of innovative engineering and expert clinical care, continues to set new standards in the treatment of esophageal conditions (70).

Transforming gastrectomies with robotic precision

Robotic technology has similarly revolutionized the practice of gastrectomies, offering a refined approach that balances the need for complete disease removal with the preservation of healthy stomach tissue. Gastrectomy, often undertaken for conditions such as gastric cancer or severe ulcerative disease, requires meticulous dissection and reconstruction, which can be significantly enhanced by the superior control offered by robotic systems. The HD, magnified views and enhanced instrument dexterity facilitate precise resection and careful handling of critical anatomical structures, ensuring that the boundaries of healthy and diseased tissue are clearly distinguished and preserved as much as possible (72). Through an RCT, Ojima et al. found that while there was no significant difference in intra-abdominal infectious complications between LG and RG, the overall incidence of postoperative complications (grade II or higher) was significantly lower in the RG group (8.8%) compared to the LG group (19.7%) (P=0.02). Additionally, severe complications (grade IIIa or higher) were also significantly lower in the RG group (5.3%) than in the LG group (16.2%) (P=0.01), indicating a potential advantage of robotic-assisted surgery in reducing postoperative morbidity (33).

This technology not only optimizes the removal of the affected tissue but also contributes significantly to the reconstruction phase of the operation. The robotic system’s refined capabilities are particularly valuable during the formation of new connections within the digestive tract. By providing stable visualization and improved instrument articulation, the platform can facilitate precise suturing and contribute to reducing the risk of leakage (meta-analysis: anastomosis-site leakage no significant difference RG vs. LG; OR 0.93, 95% CI: 0.67–1.29; P=0.67; duodenal stump leakage OR 0.88, 95% CI: 0.53–1.45; P=0.61) (27), although outcomes ultimately remain dependent on the surgeon’s technical skill and judgment. This level of precision is paramount in preventing postoperative complications and promoting a swift return to normal digestive function (73).

From the surgeon’s side, robotic platforms lower physical and cognitive workload compared with laparoscopy. Systematic reviews consistently report reduced musculoskeletal strain and lower NASA-TLX workload scores at the console than during conventional laparoscopy. In a randomized trial of colorectal resections using an open-console system, surgeons had lower ergonomic risk scores and lower cognitive strain with robotics (no trade-off in team communication or clinical outcomes). These gains are attributed to neutral posture at the console, stable 3D visualization, tremor filtration, and motion scaling, which together limit repetitive shoulder/neck loading and micro-corrections during fine suturing and lymphadenectomy. These workload benefits are reproducible across minimally invasive domains and are directly applicable to prolonged upper-GI procedures (52,74,75).

Beyond that, the continuous feedback offered by robotic systems fosters an environment of ongoing learning and adaptation. Surgeons can review recorded procedures to refine techniques and develop new strategies for addressing complex cases, thereby continuously enhancing the quality of care provided. In this way, robotic technology in gastrectomy is not simply a tool for performing surgery, but it represents a dynamic platform that supports innovation, personalized care, and long-term improvement in surgical practice (76,77).

Through these advancements, robotic-assisted gastrectomy has transformed into a procedure that not only meets but exceeds the standards of traditional surgical methods. This technology-driven evolution has resulted in fewer complications and a significant enhancement in patient quality of life, with long-term outcomes generally comparable between RG and LG; for example, OS (HR 0.96, 95% CI: 0.86–1.07) and recurrence-free survival (RFS) (HR 0.98, 95% CI: 0.80–1.21) showed no significant differences between the two approaches (27).

Despite all the abovementioned advantages, robotic surgery is limited by practical and clinical considerations. Acquisition and maintenance costs remain substantial, and the steep learning curve can delay widespread proficiency, particularly in complex oncologic resections. Patient acceptance also varies across healthcare systems, and robotics introduces unique risks such as port-site tissue compression injuries (78-80). These challenges highlight the need for structured credentialing and careful patient selection.

AI in surgical decision-making

Advancing surgical insight with AI

AI is increasingly recognized as a crucial ally in modern surgery, offering deep insights that improve decision-making throughout the patient care continuum. By processing extensive amounts of information, from detailed imaging studies to comprehensive patient histories, advanced algorithms identify patterns that might not be immediately apparent. This enriched perspective allows surgeons to anticipate potential challenges and design customized treatment strategies that cater to each patient’s unique profile (81).

Elhage et al. developed and validated image-based deep learning (DL) models to predict surgical complexity and postoperative complications in abdominal wall reconstruction. The study demonstrated that these models could discern subtle variations in preoperative imaging, allowing for precise risk stratification and tailored surgical planning. This breakthrough highlights the ability of DL to identify nuanced patterns in medical images, inspiring similar applications in surgical diagnostics and enhancing patient-specific treatment strategies. The continuous evolution of ML models, capable of adapting to new data, ensures that surgical planning remains both current and tailored to individual patient needs. In effect, AI serves as a vigilant assistant, augmenting clinical judgment with robust, data-driven insights that refine both preoperative planning and intraoperative execution (82). Table 3 summarizes key applications of AI in upper GI surgery, highlighting its role across various stages of the surgical process (30-33,83-85).

AI-enhanced imaging in cancer detection

The prompt identification of neoplastic diseases constitutes a fundamental component of effective therapeutic interventions, and AI-enhanced imaging has surfaced as a revolutionary instrument within this field. State-of-the-art algorithms now analyze images derived from magnetic resonance imaging (MRI), computed tomography (CT) scans, and endoscopic procedures to illuminate irregularities that may signify the incipient phases of malignancy (86-88). In a pertinent study published in the journal Cancers in 2021, Tsai et al. developed a DL diagnostic model that utilized hyperspectral imaging to identify and stage esophageal cancer. The model demonstrated high accuracy in detecting early-stage esophageal cancer, effectively identifying subtle signs that might be overlooked during standard examinations (89).

Building on these diagnostic advances, detailed AI imaging not only sharpens tumor margin detection and guides precise resections but also enables surgeons to remove cancerous tissue more completely while preserving healthy structures, thereby reshaping oncologic surgery into a more timely, targeted, and outcome-driven discipline (90,91).

Real-time guidance during surgery

The intricate nature and multifaceted complexity inherent in surgical procedures necessitate a continuous state of vigilance on the part of the medical professionals involved, and in this context, AI has emerged as an essential asset, providing real-time guidance that not only serves to reassure the surgical team but also proves to be invaluable in enhancing the overall efficacy of surgical interventions. During the course of an operation, advanced AI systems meticulously analyze live video feeds in conjunction with data obtained from a myriad of intraoperative sensors, thereby offering instantaneous recommendations that are instrumental in assisting surgeons as they navigate the often challenging anatomical landscapes presented during complex surgical tasks. An aforementioned study discusses the potential of AI to enhance surgical procedures, including laparoscopic surgeries, by reducing technical errors and improving patient outcomes. The authors highlight how AI can assist in real-time decision-making, error prevention, and augmenting surgical skills, thereby contributing to increased surgical safety (92).

AI functions as a real-time partner in the operating room, providing continuous feedback that alerts surgeons to subtle changes and potential hazards, a capability that is particularly critical when working near vital structures. By combining extensive anatomical data with the live surgical field, it guides each movement and decision, creating a more fluid and confident procedure that minimizes risks and supports smoother recoveries (93,94).

Postoperative monitoring: a new era of AI support

The recovery period following surgery is as critical as the operation itself, and today’s advancements in AI are reshaping postoperative care into a proactive, continuously adaptive process. Rather than relying solely on periodic check-ups and manual evaluations, modern AI-driven systems continuously collect and analyze data from wearable sensors, follow-up imaging, and electronic health records. This real-time monitoring provides clinicians with a dynamic picture of a patient’s recovery, ensuring that even the subtlest deviations from expected progress are quickly identified (95,96).

Imagine a scenario where every heartbeat, temperature change, or minor fluctuation in blood pressure is monitored with precision and care. Recent studies have demonstrated the potential of AI in early detection of postoperative complications, leveraging time-series data from electronic health records and real-time monitoring systems. One such study used ML algorithms to analyze patient data, effectively identifying early warning signs of complications like infections or impaired wound healing before clinical symptoms became apparent. By enabling healthcare providers to adjust treatment protocols swiftly, this approach significantly reduced the risk of severe complications and improved patient outcomes (97). Another investigation reinforced these findings by demonstrating that AI-driven predictive models could assess patient vitals with high accuracy, allowing for timely interventions that minimized recovery time and enhanced overall surgical safety (98). Together, these studies highlight how AI-driven surveillance can transform postoperative care, ensuring proactive rather than reactive medical intervention.

Moreover, the role of AI in postoperative monitoring extends beyond mere data collection. The technology interprets complex patterns and trends over time, offering personalized insights into each patient’s recovery journey. For instance, by analyzing trends in a patient’s physical activity, sleep quality, and vital signs, AI systems can suggest tailored modifications to rehabilitation plans or medication regimens. This level of customization ensures that recovery is not a one-size-fits-all process but is instead finely tuned to the individual needs and progress of each patient (99). Such personalized care nurtures not only physical healing but also emotional well-being, as patients and their families feel reassured by the continuous, attentive oversight of their recovery. Yet, it is equally important to recognize that excessive reliance on monitoring technologies may risk overwhelming patients and their caregivers, potentially adding stress during an already vulnerable period. Ensuring that these tools are applied with sensitivity and balance is therefore essential to avoid counterproductive effects on recovery.

In a broader sense, AI transforms postoperative care into a seamless continuum of support that bridges the gap between hospital care and home life. The technology facilitates better communication between surgical teams and primary care providers, ensuring that critical information about a patient’s recovery is shared promptly and accurately. This integrated approach fosters a more coordinated and responsive healthcare environment where every detail, from pain management to wound care, is continuously refined. The result is a more holistic healing process, one where technology and human compassion converge to create an experience that is as nurturing as it is effective (90). As postoperative monitoring becomes increasingly sophisticated, it stands as a testament to how AI can humanize technology, providing care that is both smart and deeply attuned to the individual needs of each patient.

Although the potential of AI in perioperative care is considerable, several barriers still limit its routine use. Many systems are developed and tested in narrow datasets, and their performance often declines when applied to broader, more diverse populations. Incorporating these tools into real-time surgical practice remains technically challenging, while unresolved issues around data governance and cybersecurity complicate their deployment. Finally, both physician confidence and patient acceptance of algorithm-assisted decision-making are still evolving (92,100,101).

The impact of 3D printing on personalized surgical solutions

Personalization at its best: 3D printing in upper GI surgery

The application of 3D printing in upper GI surgery epitomizes the potential for personalization in modern medicine. Surgeons are now able to design and produce models that mirror the intricate structures of a patient’s GI system, offering an unprecedented level of detail. This capability not only allows for the precise mapping of disease and anomalies but also facilitates thorough preoperative planning. By having a physical model in hand, the surgical team can simulate procedures, rehearse complex maneuvers, and even explore alternative approaches before stepping into the operating room (102,103).

Beyond preoperative rehearsal, the tangible nature of these models fosters a more intuitive grasp of spatial relationships within a patient’s anatomy. Clinicians have described the experience as akin to “seeing with your hands”, where the ability to touch and manipulate an exact replica of the affected region informs decision-making in ways that 2D images simply cannot. Research in this arena has revealed that such models can reduce intraoperative uncertainties and decrease operating times, as surgeons enter the procedure with a finely honed strategy tailored to the patient’s unique anatomy (104,105). This transformative synergy between advanced imaging and hands-on practice exemplifies the human-centric advancement that 3D printing brings to personalized care.

Importantly, the customization enabled by 3D printing extends its benefits to patient education and engagement. When patients are presented with a model of their own anatomy, the abstract becomes concrete, and the surgical plan becomes more comprehensible. This not only cultivates trust but also empowers patients to engage actively in their healthcare choices, fostering a collaborative relationship that is essential for successful outcomes (106).

Patient-specific models for complex cases

Patient-specific models have emerged as one of the most notable applications of 3D printing within upper GI surgery, providing a tailored methodology for complex cases that necessitate an exceptional degree of accuracy. Comprehensive imaging data acquired through modalities such as CT scans and MRI can be converted into high-fidelity, life-sized replicas of an individual patient’s anatomy, accurately depicting even the most elaborate vascular and organ structures (13,34,107).

In a noteworthy case report, the application of a 3D-printed model in robotic esophagogastric surgery enabled the surgical team to simulate the procedure, recognize potential challenges, and modify their strategic approach accordingly, culminating in abbreviated operative durations and a reduction in postoperative complications. This case illustrates how a tangible, patient-specific model can function as both a preparatory instrument and an educational resource, directing surgeons through complex anatomical terrains with a degree of assurance and precision that conventional imaging methodologies are unable to provide (49).

The capacity to rehearse the procedure on an exact replica of the patient’s anatomy can yield invaluable insights that lead to fewer intraoperative adjustments and a smoother postoperative recovery. Such applications underscore the significant influence that patient-specific models can exert on surgical outcomes, emphasizing the value of personalized preoperative planning in complex GI cases. Table 4 outlines the extensive applications of 3D printing in enhancing surgical training and preoperative planning (34-36,49,53,107-113).

However, the clinical translation of 3D printing faces significant barriers. Production of models often requires several days, limiting its use in urgent surgical settings, and costs remain substantial. Material science has not yet produced widely available biocompatible substrates with sufficient durability, and clinical evidence supporting routine benefit is still limited (114,115). These factors could explain why implementation in upper GI surgery has been gradual.

The future of bioprinting in GI surgery

Bioprinting is an emerging field in personalized GI surgery that extends beyond traditional 3D printing by utilizing living cells and biocompatible materials to create tissue constructs. This innovative approach aims to develop dynamic, functional tissue replacements capable of integrating seamlessly with a patient’s biological systems. Recent studies have demonstrated the potential of 3D bioprinting in tissue engineering, highlighting its advantages over conventional methods (108). For instance, researchers have successfully developed scaffolds laden with cells that closely mimic the mechanical properties and cellular composition of native tissues, paving the way for future applications in GI surgery (109). These advancements suggest a future where damaged segments of the GI tract could be reconstructed with bioprinted tissues that restore both structure and function. In principle, this could extend to the creation of esophageal segments, providing an alternative to gastric conduits in patients requiring reconstruction after resection. Similarly, bioprinted patches may one day be used for localized gastric or duodenal defects, reducing the need for extensive resections and complex reconstructions. These possibilities highlight the potential of bioprinting to broaden the spectrum of reconstructive strategies in upper GI surgery (108-110).

Real-world research is already laying the foundation for clinical advances, with surgeons and bioengineers working together to address critical barriers such as vascularization, the integration of blood supply into printed tissues that is essential for their long-term survival and function. Several studies offer a glimpse of a future in which bioprinted grafts could be implanted to repair defects, reducing the dependence on donor organs and minimizing the complexity of reconstructive surgery (110-112). In situations where conventional approaches achieve limited success, these innovations may provide transformative alternatives.

Looking ahead, the integration of bioprinting into GI surgery promises a new era of regenerative medicine that is both highly personalized and profoundly innovative (116). As bioprinting advances toward clinical adoption, it may redefine surgical practice by enabling regenerative solutions that restore both structure and function, offering possibilities that extend well beyond the limits of current reconstructive methods (117).

Integrating advanced technologies: a synergistic approach

Real-world applications of combined technologies in upper GI surgery

The convergence of robotics, AI, and 3D printing is now being translated into transformative practices in upper GI surgery. These integrated technologies are enabling surgeons to tackle cases that were once considered too complex for conventional methods. Instead of functioning independently, each technological component enhances the others, culminating in a holistic approach that is meticulously customized to meet the unique requirements of each patient (17,118,119).

One study exemplified how surgeon-bioengineer collaboration can harness AI-aided imaging and 3D printing in upper GI surgery. For instance, Marano et al. described the creation of a full-scale 3D-printed esophageal model, including the thoracic aorta and proximal stomach, that surgeons used during preoperative evaluation and intraoperative guidance to navigate complex anatomy of the esophagogastric junction (49). Similarly, another study indicated that patient-specific GI models improve surgeons’ spatial understanding and procedural confidence, offering a more tangible approach to planning than 2D imaging (120).

Another compelling instance involved a study, in which a multidisciplinary team utilized preoperative CT angiography (CTA) to reconstruct 3D images of the patient’s vascular anatomy. These images were integrated into the robotic surgical system, providing real-time, image-enhanced guidance during the minimally invasive procedure. This approach allowed for precise identification of vascular structures and facilitated meticulous lymphadenectomy, thereby minimizing the risk of vascular injury (53).

A third example comes from an upper GI case involved a patient with esophageal carcinoma complicated by a rare double aortic arch, a vascular malformation that significantly altered mediastinal anatomy. To plan the approach, surgeons collaborated with engineers to build a 3D-printed patient-specific model comprising the esophageal cancer and surrounding vascular structures derived from imaging data. This model guided preoperative planning and defined a bilateral thoracoscopic esophagectomy strategy. The actual surgery was assisted by robotic technology, enabling precise dissection amidst distorted anatomy. This example underscores how imaging, 3D modeling, and robotics can synergize to optimize safety and precision in complex upper GI oncology (113). The broader integration of 3D printing, AI, and robotics in upper GI surgery is summarized in Table 5 (14,27,30-34,39,56,57,65,77,83,108-111,121,122).

Addressing barriers to innovation

Real-world challenges in adopting cutting-edge technologies

The transition of innovative instruments from theoretical frameworks to clinical settings necessitates the navigation of complex challenges that transcend mere technological considerations. Despite the considerable prospective advantages associated with robotics, AI, and 3D printing, their practical execution frequently encounters significant practical roadblocks. Healthcare organizations are compelled to contend with a multitude of concerns, including regulatory hurdles, institutional resistance, and the nuanced processes involved in the integration of novel systems with pre-existing infrastructures. These challenges are not abstract. They impact routine operations and may obstruct or limit patient access to innovative care. It should also be recognized that the relevance of each challenge and the feasibility of proposed solutions differ significantly across healthcare systems. For example, financial barriers may dominate in low-resource settings, while regulatory approval processes are often the limiting factor in high-income, insurance-based environments. Clarifying these distinctions is essential to ensure that strategies are tailored to the context in which they are applied (31,123,124).

The obstacles are as heterogeneous as the technologies themselves. Establishing robust digital networks that can support advanced AI systems, or ensuring that robotic platforms are seamlessly integrated into operating theaters, requires careful coordination among multiple stakeholders. This collaborative effort demands not only technical expertise but also strong leadership and strategic planning (125). By addressing these challenges head-on, healthcare providers can pave the way for more fluid adoption of innovative technologies, ultimately leading to enhanced patient outcomes and a more sustainable future in surgical care. Table 6 summarizes challenges and strategies for integrating cutting-edge technologies into GI surgery, focusing on reducing barriers and improving accessibility (33,36,52,81,92,96,126-130).

Financial and logistical barriers

The cost of pioneering medical technology remains one of the most significant barriers to its widespread adoption. High initial investments, coupled with ongoing expenses for maintenance, software updates, and technical support, can place advanced systems out of reach for many institutions. Smaller hospitals and clinics, which often operate with tighter budgets, may find it particularly challenging to justify such expenditures despite the potential long-term savings and improved outcomes that these tools can provide. Funding constraints are compounded by the need for infrastructure upgrades, including specialized facilities and network systems capable of supporting sophisticated devices (131).

Logistical challenges also play a critical role in restricting the progress of innovation. The process of integrating new technologies into established workflows requires time and substantial effort. Hospitals must navigate complex procurement processes, manage supply chain uncertainties, and sometimes contend with a lack of technical personnel skilled in the installation and maintenance of advanced systems. On top of that, aligning these new tools with existing electronic health records and other digital systems often demands significant customization and ongoing collaboration between vendors and clinical teams (124). Overcoming these financial and logistical obstacles requires financing strategies aligned with the country and payer context (for example, tax-funded or insurance-based systems), public and private partnerships, and plans that balance short-term costs with long-term value (130,132).

Training surgeons for advanced tools

Equally critical to the successful deployment of new technologies is the need to train the surgeons and support staff who will be using them. The rapid pace of technological change in surgery means that established practitioners must continuously update their skills, a process that can be both time-consuming and demanding. Traditional surgical training methods, while robust, are often not designed to accommodate the intricacies of digital and robotic systems, leaving a gap between what current surgeons know and what the new technology requires (133).

To bridge this gap, innovative training programs are being developed that incorporate simulation, virtual reality (VR), and hands-on workshops. These programs aim to shorten the learning curve by offering immersive experiences that mirror real-life scenarios without the associated risks. Institutions that invest in such educational initiatives tend to see faster integration and higher proficiency with the new tools. In addition, mentorship and peer-led training sessions have proven invaluable, as experienced practitioners share their insights and adapt emerging techniques to everyday practice. The goal extends past the basic transfer of technical abilities. It endeavors to nurture a mindset of lifelong education and adaptability. When surgeons feel confident and well-supported, the potential of these advanced tools can be fully realized, translating into improved surgical outcomes and enhanced patient care (134).

Realizing the potential of emerging technologies

Augmented and VR in upper GI surgery

In recent years, VR and augmented reality (AR) have begun to reshape the way upper GI procedures are conceptualized and executed. These immersive technologies offer clinicians a window into the intricacies of patient anatomy by transforming digital imaging data into interactive 3D environments. Surgeons can explore a virtual representation of a patient’s digestive tract long before the actual operation, allowing them to identify potential challenges and refine their approach. This technology fosters a more profound understanding of spatial relationships within the body, which is crucial when planning delicate interventions (135).

Beyond preoperative planning, these tools have proven invaluable in the operating room. AR systems can project critical anatomical details directly onto the surgical field, ensuring that the surgeon is continuously aware of hidden structures during the procedure. This real-time overlay of digital information enhances precision and helps avoid inadvertent injury to surrounding tissues. In one pioneering case at a leading medical center, a surgical team utilized an AR system to navigate a particularly challenging resection, resulting in improved accuracy and reduced operation time. Such successes illustrate how these technologies are not only enhancing technical performance but also contributing to more predictable patient outcomes (136).

Furthermore, VR has emerged as an essential training resource for both new and experienced surgeons. By simulating complex procedures in a risk-free environment, VR platforms enable practitioners to hone their skills and experiment with innovative techniques. This immersive training approach has proven to be an effective way to build confidence and improve operative performance. The collaborative nature of these simulations also encourages teamwork and communication. For instance, VR platforms allow entire operative teams, including surgeons, anesthesiologists, and nursing staff, to rehearse procedures together in a shared environment. This enables role clarification, coordination of intraoperative tasks, and structured communication under simulated stress, which can translate into more cohesive and effective surgical performance in real cases (137).

Next-generation imaging systems for better diagnostics

The evolution of diagnostic imaging is establishing a new paradigm in upper GI surgery, delivering unprecedented clarity and detail that greatly enhance clinical decision-making. Cutting-edge modalities now provide HD, multi-dimensional views of patient anatomy, revealing subtle details that were once hidden. This breakthrough in imaging enables early detection of pathological changes, setting the stage for prompt and precise therapeutic interventions (138).

Innovations in contrast techniques and real-time data capture further elevate the diagnostic process by offering dynamic insights into the functional aspects of the GI system. Modern imaging devices can now track physiological processes in motion, allowing physicians to observe how tissues and organs interact under various conditions. This level of functional imaging is instrumental not only in identifying early abnormalities but also in monitoring disease progression and assessing responses to treatment. Recent clinical studies have highlighted that these next-generation imaging systems can significantly reduce diagnostic ambiguity, especially in cases involving intricate tumors or subtle mucosal changes (30-32,89,138).

Additionally, the integration of these state-of-the-art imaging tools with analytical software is revolutionizing the continuum of patient care. By combining high-resolution images with powerful computational analysis, clinicians are equipped to develop individualized diagnostic profiles. This tailored approach ensures that each patient receives the most accurate evaluation and the most effective treatment strategy available. As these imaging approaches evolve, they are poised to decrease the invasiveness associated with diagnostic procedures, consequently improving both patient safety and comfort while at the same time augmenting overall clinical outcomes (139).

Conclusions

The fusion of robotics, AI, and 3D printing is effecting a significant transformation in upper GI surgery, thereby enhancing precision, operational efficiency, and individualized patient care (24,96). Robotic platforms elevate dexterity and stable visualization in confined fields, supporting meticulous dissection and reconstruction (24,49,50). AI-driven tools assist with early lesion detection, perioperative risk assessment, and intraoperative guidance in esophageal and gastric disease (30-32). Patient-specific 3D models and emerging implant applications strengthen preoperative planning and case personalization (34,36). Together, these advances expand what is achievable in modern surgical practice while keeping clinical judgment at the center.

Barriers remain that shape real-world adoption, including costs, training needs, integration with existing systems, and regulation (33,92). Current evidence indicates fewer conversions and lower overall complications with RG, modest reductions in blood loss, and long-term outcomes comparable to laparoscopy (27,64). In esophagectomy, robotic-assisted approaches report lower recurrent laryngeal nerve palsy, and operative efficiency improves with program experience (66,69). Equitable implementation will also require attention to access and infrastructure in low- and middle-income settings (130). Overall, the trajectory points to minimally invasive, data-enabled, and personalized upper GI surgery that prioritizes safety, recovery, and patient-centered outcomes.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://ales.amegroups.com/article/view/10.21037/ales-25-23/rc

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Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://ales.amegroups.com/article/view/10.21037/ales-25-23/coif). S.P. serves as an unpaid editorial board member of Annals of Laparoscopic and Endoscopic Surgery from December 2024 to December 2026. The other author has no conflicts of interest to declare.

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