Research hotspots and trends of robotic rectal cancer surgery: a bibliometric analysis (2006-2025)

Research hotspots and trends of robotic rectal cancer surgery: a bibliometric analysis (2006-2025) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Research hotspots and trends of robotic rectal cancer surgery: a bibliometric analysis (2006-2025) Hao Shi, Wenjie Wu, Hao Hu, Qiang Lü, Xianhao Yi, Qiulin Huang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7879365/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Nov, 2025 Read the published version in Journal of Robotic Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract Rectal cancer is a common digestive malignancy with complex surgical challenges due to pelvic anatomy. Robotic-assisted surgery has gained traction for its superior precision and ergonomics over laparoscopy. This bibliometric analysis of 598 English-language publications (2006–2025) from the Web of Science explores global research trends. Using CiteSpace and VOS viewer, the study identifies leading contributors (USA, Japan, China), top institutions (Tokyo Medical and Dental University, Tokyo University of Science, Cleveland Clinic), and key authors (Kinugasa, Shiomi, Kagawa). Early studies emphasized technical aspects; recent work focuses on survival, risk stratification, and comparisons with open surgery. The field is shifting toward personalized care, though wider adoption and institutional collaboration remain crucial. Robotic surgery rectal cancer bibliometrics hotspots trends Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Colorectal cancer (CRC) is among the most common malignancies worldwide, with rectal cancer accounting for one-third of cases[ 1 ]. Although overall CRC incidence and mortality are declining, rectal cancer in individuals under 50 is rising sharply[ 2 ]. Robotic-assisted rectal cancer surgery has become one of the most widely performed robotic procedures, and related research is crucial for understanding surgical development trends [ 3 , 4 ]. Over the past 40 years, rectal cancer treatment has advanced through standardized surgical techniques and high-resolution imaging, guiding neoadjuvant therapy, precise surgery, and pathological evaluation for adjuvant chemotherapy[ 5 ]. It is now defined by diagnostic precision, diverse treatment options, and improved patient quality of life. Surgical approaches include open, laparoscopic, and robotic methods. Robotic surgery, with enhanced 3D vision and flexible instruments, offers greater precision [ 6 ]. It has matured in recent years, showing benefits such as reduced blood loss, higher sphincter preservation rates, and fewer complications like infection, obstruction, leakage, and urinary retention [ 7 ]. Current research primarily focuses on developing new surgical techniques and applying evidence-based medicine to evaluate the effectiveness and safety of robotic surgery. However, comprehensive reviews on the overall progress of robotic rectal cancer surgery remain limited[ 8 ]. CiteSpace and VOS viewer are bibliometric tools that integrate visualisation and data mining to analyse literature, track development trends, and predict research hotspots[ 9 ]. Although numerous studies on robotic rectal cancer surgery exist globally, comprehensive statistical and visual analyses remain limited[ 10 ]. To address this gap, we conducted a bibliometric study using CiteSpace and VOS viewer to identify key research areas, emerging hotspots, and future directions in robotic rectal cancer surgery [ 11 ]. We analyzed annual publication volume, contributing countries, institutions, authors, and keywords to assess the current research landscape and provide a reference for clinical advancement in this field. Materials and Methods Data retrieval Publications on robotic rectal cancer surgery from January 1, 2006, to July 22, 2025, were retrieved from the Web of Science Core Collection (WoSCC) using the search: TI = ("robotic surgery" OR related terms) AND TS = ("rectal cancer" OR related terms). No restrictions were applied regarding date, language, or publication status. Inclusion and exclusion criteria and screening strategies Inclusion criteria were: (1) studies on robotic rectal cancer surgery; (2) English language; (3) sourced from WoSCC; (4) publication type as "articles" or "reviews"; (5) published between January 1, 2006, and July 22, 2025. Exclusion criteria included unrelated topics and non-designated publication types (e.g., abstracts, case reports). All full texts were reviewed, and the corresponding author settled unresolved disagreements. Data were exported in plain text format. Variables and Analysis For each included publication, data on author, country, institution, Journal, and keywords were extracted. VOS viewer (v1.6.20) and CiteSpace (v6.3.1) were used for visualization and analysis. CiteSpace identified keywords with intense citation bursts to explore research frontiers in robotic rectal cancer surgery[ 12 ]. Journal Citation Reports (JCR) and 2025 impact factors (IF) were included to assess scientific value. Results Annual growth trend of publications on robotic rectal cancer surgery From January 1, 2006, to July 22, 2025, 598 publications on robotic rectal cancer surgery were identified, including 498 articles (83.28%) and 100 reviews (16.72%). Supplementary Figure S1 shows the literature search flowchart. Publication trends remained flat until 2021, then rose sharply, peaking in 2024 (Fig. 1 ).3.2 National and institutional cooperation networks. The included literature originated from 153 countries and regions (Fig. 2 ). The top five contributors were the United States (n = 137), Japan (n = 85), China (n = 81), South Korea (n = 51), and Germany (n = 40) (Table 1 ), with six of the top ten countries showing centrality > 0.1. The U.S. led in publications and made notable contributions between 2020 and 2025. Among the top 10 most-published papers, four were from Japan, three from the U.S., two from South Korea, and one from Denmark (Supplementary Figure S2). Tokyo University of Medical and Dental Sciences and Tokyo University of Science each published 13 papers; the Cleveland Clinic published 11. The University of Texas had the highest citation count at 1,509 (Table 2 ). Table 1 The top 10 most prolific countries Rank Country Centrality Link strength Count Citations Citation Per articles 1 USA 0.46 50 137 6129 44.73 2 Japan 0.00 5 85 817 9.6 3 China 0.00 6 81 2400 29.6 4 South Korea 0.07 12 51 2759 54.1 5 Germany 0.32 21 40 366 9.2 6 England 0.64 44 39 1619 41.5 7 Italy 0.67 31 34 2893 85.1 8 Spain 0.13 18 24 535 22.3 9 France 0.37 27 23 384 16.7 10 Netherlands 0.07 11 19 211 11.1 Table 2 The top 10 most prolific institutions Rank institution country Centrality Count Citations Citation Per articles 1 Tokyo Medical & Dental University Japan 0.00 13 256 19.7 2 Institute of Science Tokyo Japan 0.00 13 156 12.0 3 Cleveland Clinic Foundation USA 0.00 11 35 3.2 4 Korea University Korea 0.00 10 452 45.2 5 Shizuoka Cancer Center Japan 0.00 10 481 48.1 6 University of Texas System USA 0.00 9 1509 167.7 7 Korea University Medicine Korea 0.00 9 387 43 8 University of Copenhagen Denmark 0.00 9 139 15.4 9 Kaohsiung Medical University Japan 0.00 9 384 42.7 10 Intuitive Surgical USA 0.00 9 105 11.7 Journal analysis Publications in the field of robotic rectal cancer surgery were distributed in 174 journals. Of the top 10 most frequently published journals, 70% were classified as Q1, 20% as Q2, and 10% as Q4(2. the most published journals were Surgical Endoscopy (n = 62), Journal of robotic surgery (n = 35), and Diseases of the colon & rectum (n = 35) (Fig. 3 , Supplementary Table S1 ). the most co-cited Journal was Surgical Endoscopy (2137 citations), followed by Annal of surgery (1245 citations) and Diseases of the colon & rectum (1073 citations) (Supplementary figure S3, Supplementary Table S1 ). Nine of the top 10 cited journals were JCR sub-region 1. Jama-Journal of the American Medical Association had the highest impact factor (63.1). The double-stack graph describes the discipline distribution, citation trajectory and the transfer of research centres of academic journals[ 13 ]. We found that surgical studies were frequently cited by healthcare and medical journals, in addition to clinical surgical journals (Supplementary figure S4). Author analysis Over the past 19 years, 3217 researchers have contributed to robotic rectal cancer surgery studies (Supplementary Table S2). The most prolific author was Kinugasa Yusuke (19 articles), followed by Shiomi Akio (14), Kagawa Hiroyasu (13), Pigazzi Alessio (10), and Huang Ching-Wen (9), with top contributors from Japan, Singapore, the U.S., and South Korea. Pigazzi had the highest citation count (1958), while Baik Seung Hyuk led in co-citations (199) (Supplementary Figure S5). Citation trajectories peaked in 2014, 2019, and 2020 (Supplementary Figure S6). Research themes are split between perioperative complications and future applications of robotic surgery. Co-citation reference analysis and timeline Co-cited literature is defined as publications cited by other authors and considered to represent the knowledge base in a field[ 14 ]. Co-cited articles were divided into seven clusters (Supplementary figure S7). All the clusters were closely related to the topic of our study. The highest-cited article was a publication in the Journal of the American Medical Association (IF = 55). The title is "Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomised Clinical Trial. "It has been cited 170 times in total[ 15 ]. he timeline view is a data visualization method that combines clustering and time-slicing techniques to display the trends and interrelationships of research topics over time, while also illustrating the distribution of problems within the field[ 16 ]. The most frequently occurring word in each cluster was identified as the cluster label. We therefore plotted a timeline view of the co-cited literature (Supplementary figure S8). We found that "Da Vinci robotic surgery study" and "large randomized controlled trials" were the research focus of robotic rectal cancer surgery. "Learning curve of robotic surgery" and "total mesorectal excision" are new research hotspots. They are developed from the previous further deepening[ 17 ]. The top co-cited reference was the article entitled "Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomised Clinical Trial" from The Journal of the American Medical Association (IF = 55), which was cited a total of 170 times (Supplementary Table S3). Keyword co-occurrence, clustering and emergence analysis After filtering irrelevant terms via CiteSpace, the top five keywords were "total mesorectal excision," "laparoscopic surgery," "short-term outcomes of robotic rectal cancer surgery," "randomized controlled trials," and "learning curve of robotic rectal cancer surgery" (Supplementary Table S4). Keyword evolution reflects shifts in research frontiers[ 18 ]. A timeline view revealed 10 clusters, with key themes since 2018 including postoperative complications, mesorectal excision, robotic surgery prospects, randomized trials, learning curves, lateral lymph node dissection, resection quality, and total neoadjuvant therapy (Supplementary Figure S9). Emergent keywords, those with high citation bursts, highlight frontier topics[ 19 ]. Seventeen keywords showed intense bursts from 2006 to 2025 (Fig. 4 ), with "short-term outcome," "experience," "MRC CLASICC trials (Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer Trial)," and "survival" ranking highest. "Open resection," "risk," and "survival" remain active hotspots through 2025. Discussion The overall development trend of robotic rectal cancer surgery The overall development trend of robotic rectal cancer surgery To assess global research trends in robotic rectal cancer surgery, this study conducted the first bibliometric analysis of 19 years of publications from the WoSCC. The analysis revealed growth in publication volume, as well as collaboration networks among countries, institutions, journals, and authors, and frequently cited keywords. Research focus has shifted from "experience accumulation" and "clinical trials" to "patient safety" and "efficacy." Current hotspots include "survival," "risk," and "open resection." This study provides a comprehensive knowledge map to guide future research and clinical practice. Global Research Contributions This study found that the United States, China, and Japan are leading contributors to robotic rectal cancer surgery research. The U.S. had the highest publication count and citation frequency, while Japanese authors were the most prolific. These trends align with global epidemiological patterns. Surgery remains a primary treatment for rectal cancer, with robotic minimally invasive surgery offering technical advantages over open and laparoscopic methods, especially in confined spaces[ 20 ]. Since FDA approval of the Da Vinci system in 2000, robotic surgery has expanded across multiple specialties[ 21 ]. As the only FDA-approved soft-tissue robotic platform, Da Vinci provides enhanced 3D visualization and instrument flexibility, improving surgical precision[ 22 ]. Robotic rectal cancer surgery represents a long-term direction in surgical innovation, enhancing outcomes and training opportunities. This study systematically analyzed 598 publications from the past 19 years using bibliometric methods[ 23 ]. Status quo and optimization path of the institutional and author collaboration model Using CiteSpace and VOS viewer, this study visualised and analysed literature on robotic rectal cancer surgery. The top publishing institutions were Tokyo University of Medical and Dental Sciences, Tokyo University of Science, and Cleveland Clinic—major cancer centres and comprehensive universities—highlighting the role of high-level medical research institutions. The institutional cooperation network revealed 72 connections with a density of 0.0522, indicating moderate collaboration but overall limited strength[ 24 ]. Contributing factors include regional disparities, long training cycles, uneven distribution of training centres, and weak interdisciplinary communication. To address this, the study recommends establishing standardized robotic surgery training centres, developing multidisciplinary simulation systems, and promoting skills competitions and collaboration mechanisms[ 25 ]. These efforts could enhance institutional and cross-specialty cooperation, advancing robotic colorectal surgery research and practice[ 10 ]. According to the author co-map, Kinugasa Yusuke (19 papers), Shiomi Akio (14), and Kagawa Hiroyasu (13) were the most prolific contributors. Academic productivity often correlates with socioeconomic status across countries[ 26 ]. While some authors formed strong collaborative networks, most cooperation occurred within the same institution or affiliated hospitals, lacking cross-agency, international, and interdisciplinary models[ 27 ]. To enhance innovation and knowledge sharing, it is recommended to strengthen collaboration, promote multicenter studies, and establish a shared public database for robotic rectal cancer surgery research. To analyze the clinical concerns and research focus of robotic rectal cancer surgery from keyword clustering Keywords reflect the core themes of research, and co-occurrence clustering maps reveal long-term hotspots and directions in robotic rectal cancer surgery[ 28 ]. From 2006 to 2025, keyword clustering formed ten groups, with #0 "Postoperative morbidity" containing the most terms. Key complications include anastomotic leakage (1–30% incidence), sexual dysfunction (up to 70% in males), urinary and defecation disorders, infections, and local recurrence[ 29 ]. Robotic surgery offers advantages in precision, reduced bleeding, faster recovery, and better Preservation of urinary and sexual function. However, its impact on postoperative complications needs further validation. While robotic surgery improves surgical quality and lowers recurrence rates, safety concerns and limited patient acceptance remain challenges[ 30 ]. The prospects of robotic surgery and the trend of technology integration Label 3 is the future of robotic surgery. The prospects of robotic rectal cancer surgery are extensive, primarily due to the deep integration of artificial intelligence and assistive technology. With the rapid development of artificial intelligence (AI) technology, AI has been gradually applied to preoperative diagnosis, intraoperative navigation and postoperative prognosis evaluation of colorectal cancer. AI combined with a robotic surgery platform can improve surgical accuracy, reduce complications, enable individualized treatment plans, provide intelligent support for diagnosis and treatment at all stages, and elevate minimally invasive treatment to a higher level[ 31 ]. With the upgrading of technology and the improvement of surgical quality, the robotic surgical system has enhanced the ability to handle the narrow space and complex anatomical structure of the pelvis through high-definition three-dimensional vision, dexterity movement and delicate operation, and achieved safer total mesorectal excision (TME), which makes postoperative functional protection more accurate, reduces bleeding and infection rates, and improves the quality of life of patients. With the expansion of multidisciplinary comprehensive treatment modes, robotic surgery will play a key role in the framework of multidisciplinary combined treatment, such as neoadjuvant chemoradiotherapy, immunotherapy, and targeted therapy, to provide better tumour control and prognosis for patients with locally advanced rectal cancer[ 32 ]. With the new trend of personalized and minimally invasive surgery, future robotic technology will support more minimally invasive surgical methods, such as single-port surgery and natural orifice surgery, to reduce postoperative trauma and accelerate recovery, and realize real-time navigation and accurate resection by integrating new technologies such as augmented reality (AR) and intraoperative imaging. Despite the apparent advantages of robotic surgery, several issues remain, including high costs, a steep learning curve, and a lack of tactile feedback. Future development should focus on cost reduction, technology popularisation, and improvement of operational experience, combined with an intelligent assistant system, to realise the popularisation and standardisation of surgery[ 33 ]. Keywords emerged to reveal the trajectory of technological innovation and clinical transformation In addition to clustering, keyword burst analysis helps identify long-lasting research themes. Time charts and zone maps illustrate the evolution of robotic rectal cancer surgery, highlighting research frontiers and guiding future directions[ 10 ]. Based on 2006–2025 literature, 17 emergent keywords were identified and grouped into five stages: Initial Exploration (2006–2010): Focused on feasibility and safety, with keywords like "experience" and "colon," reflecting early case accumulation and comparisons with open/laparoscopic surgery[ 34 ]. Evidence Accumulation (2010–2016): Marked by randomized controlled trials (e.g., "MRC CLASICC trial") and growing emphasis on "short-term outcomes" and broader "colorectal surgery." Systematic Comparison (2014–2020): Emergence of meta-analyses and "conventional laparoscopic surgery" as a comparator, shifting attention to long-term efficacy and cost-effectiveness[ 35 ]. Functional Preservation (2018–2023): Research emphasized quality of life, neurological protection, and risk stratification, with keywords like "survival" and "risk," aligning with precision medicine. Future Trends (2023–2025): Reassessment of "open resection" for complex cases, and integration of AI and intraoperative navigation, pointing toward personalized, multidisciplinary surgical models[ 36 ]. From dispersion to fusion: the process of knowledge aggregation in robotic surgery research The keyword timeline map reveals a clear evolution in robotic rectal cancer surgery research—from early technology introduction to quality control. Initial studies (e.g., "postoperative morbidity," "Da Vinci robot," "mesenteric resection") focused on feasibility and short-term outcomes. As technology advanced, mid-stage keywords like "randomised controlled trial," "learning curve," and "lateral lymph node dissection" reflected a shift toward evidence-based medicine and technical refinement, emphasising surgical training and proficiency[ 31 ]. Recent keywords such as "resection quality," "inflammatory surgical stress response," and "total mesorectal excision" highlight growing attention to surgical quality, minimally invasive benefits, and long-term prognosis optimization. Overall, keyword relationships have evolved from scattered to tightly connected, indicating increasing integration and maturity in this research field[ 37 ]. Conclusion Using bibliometric methods, this study systematically reviewed 19 years of research on robotic rectal cancer surgery, revealing global patterns, hotspot evolution, and future trends. The field has gradually shifted from technical exploration to quality control and personalized treatment. Despite clear advantages, robotic surgery still faces challenges in multicenter collaboration and technology dissemination, which are essential for broader clinical adoption and standardized development. Limitations of this study include its reliance on the WOSCC, which may result in the omission of relevant studies from other databases. Cooperation networks remain fragmented, with limited transnational and interdisciplinary integration. Additionally, while keyword clustering highlights research hotspots, clinical translation remains underexplored. Future research should expand data sources, enhance collaborative frameworks, and integrate emerging technologies such as AI and intraoperative navigation to advance precision treatment and functional Preservation in robotic surgery. Data Availability Statement The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request, subject to institutional review board approval and patient privacy considerations. Declarations Competing interests the authors declare no competing interests related to this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Ethics Approval This study did not involve human participants, animals, or their biological materials, and therefore did not require ethics approval. Consent to Participate This study did not involve human participants, and therefore informed consent was not required. Consent to Publish This study did not involve human participants or identifiable personal data, and therefore consent to publish was not required. Funding This study was supported by the Natural Science Foundation of Hunan Province (2023J60369 [SX], 2022JJ30538 [SX], 2025JJ81067 [XY], 17182025JJ81068 [XC]); the Major Scientific Research Project for High-Level Health Talents in Hunan Province (20230533 [SX], 20231526 [QH]); and the Interdisciplinary Research Program in Medicine and Engineering, The First Affiliated Hospital of University of South China (IRP-M&E-2025-12). Author Contribution Shi Hao led the study design and manuscript drafting. Wu Wenjie and Hu Hao conducted data collection and analysis. Lü Qiang and Yi Xianhao contributed to literature review and visualization. Huang Qiulin and Chen Xiangheng revised the manuscript and approved the final version. Acknowledgements The authors would like to thank all researchers and institutions whose work contributed to the bibliometric analysis of robotic rectal cancer surgery. 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Supplementary Files supplementary.pdf Cite Share Download PDF Status: Published Journal Publication published 22 Nov, 2025 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 05 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviewers agreed at journal 01 Nov, 2025 Reviewers agreed at journal 01 Nov, 2025 Reviews received at journal 01 Nov, 2025 Reviewers agreed at journal 01 Nov, 2025 Reviewers agreed at journal 01 Nov, 2025 Reviewers invited by journal 27 Oct, 2025 Editor assigned by journal 18 Oct, 2025 Submission checks completed at journal 18 Oct, 2025 First submitted to journal 16 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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10:15:43","extension":"xml","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103197,"visible":true,"origin":"","legend":"","description":"","filename":"6a2ebc3586974b5ca1ba4a15a9c8f4921structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/a46719feeb789429910bec81.xml"},{"id":95499856,"identity":"a2327bf1-2da2-4d12-9201-33b2194507ee","added_by":"auto","created_at":"2025-11-10 05:17:03","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111096,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/654eff6d18136e9e6473d3f8.html"},{"id":95499847,"identity":"88210e1c-25a0-42fd-a415-21d701a36d51","added_by":"auto","created_at":"2025-11-10 05:17:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":422598,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual trends of articles on Robot-assisted rectal cancer surgery published from 2006 to 2025\u003c/p\u003e","description":"","filename":"11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/fb011e85a9c7a4f66048f7ca.jpg"},{"id":95499848,"identity":"eb672001-5e37-43ac-bf66-95e3fde1672b","added_by":"auto","created_at":"2025-11-10 05:17:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":4813066,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of countries publishing research related to Robot-assisted rectal cancer surgery. Cooperative network of publications between countries. Countries are represented by nodes. Partnerships are represented by lines. The node area increases with the number of publications. The colors represent different years\u003c/p\u003e","description":"","filename":"12.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/517d297a8f3decf20c6974fa.jpg"},{"id":95499863,"identity":"7915c886-aa8a-4499-a07d-9633ef1a94eb","added_by":"auto","created_at":"2025-11-10 05:17:04","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":5147382,"visible":true,"origin":"","legend":"\u003cp\u003eThe visualization network of journals related to Robot-assisted rectal cancer surgery. The nodes with the same color represent the same cluster, implying a close partnership. The larger the node’s size or the width of the connecting line, the closer the relative degree of co-occurrence\u003c/p\u003e","description":"","filename":"13.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/833b106f594e0d80d90c1d5e.jpg"},{"id":95499859,"identity":"f893c1b5-0ef3-4648-ba8d-5c47a5a690a6","added_by":"auto","created_at":"2025-11-10 05:17:04","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":234044,"visible":true,"origin":"","legend":"\u003cp\u003eKeywords with the strongest citation bursts related to Robot-assisted rectal cancer surgery from 2006 to 2025. The blue line represents the time axis, with the red part indicating the start year, end year, and duration of the burst\u003c/p\u003e","description":"","filename":"14.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/d5b87ad4a58e491cdaad5404.jpg"},{"id":96650222,"identity":"de732cbb-36cf-45b0-aa97-675bb73c543b","added_by":"auto","created_at":"2025-11-24 16:10:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11593637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/2333db06-8868-4b58-9d23-fb9511b82387.pdf"},{"id":95529425,"identity":"05d51330-1b66-4418-9905-ca3253614a68","added_by":"auto","created_at":"2025-11-10 10:17:06","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":3512051,"visible":true,"origin":"","legend":"","description":"","filename":"supplementary.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7879365/v1/a3b2fdd95725d8554b60939d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research hotspots and trends of robotic rectal cancer surgery: a bibliometric analysis (2006-2025)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColorectal cancer (CRC) is among the most common malignancies worldwide, with rectal cancer accounting for one-third of cases[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although overall CRC incidence and mortality are declining, rectal cancer in individuals under 50 is rising sharply[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Robotic-assisted rectal cancer surgery has become one of the most widely performed robotic procedures, and related research is crucial for understanding surgical development trends [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOver the past 40 years, rectal cancer treatment has advanced through standardized surgical techniques and high-resolution imaging, guiding neoadjuvant therapy, precise surgery, and pathological evaluation for adjuvant chemotherapy[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is now defined by diagnostic precision, diverse treatment options, and improved patient quality of life. Surgical approaches include open, laparoscopic, and robotic methods. Robotic surgery, with enhanced 3D vision and flexible instruments, offers greater precision [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It has matured in recent years, showing benefits such as reduced blood loss, higher sphincter preservation rates, and fewer complications like infection, obstruction, leakage, and urinary retention [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCurrent research primarily focuses on developing new surgical techniques and applying evidence-based medicine to evaluate the effectiveness and safety of robotic surgery. However, comprehensive reviews on the overall progress of robotic rectal cancer surgery remain limited[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCiteSpace and VOS viewer are bibliometric tools that integrate visualisation and data mining to analyse literature, track development trends, and predict research hotspots[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although numerous studies on robotic rectal cancer surgery exist globally, comprehensive statistical and visual analyses remain limited[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To address this gap, we conducted a bibliometric study using CiteSpace and VOS viewer to identify key research areas, emerging hotspots, and future directions in robotic rectal cancer surgery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. We analyzed annual publication volume, contributing countries, institutions, authors, and keywords to assess the current research landscape and provide a reference for clinical advancement in this field.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData retrieval\u003c/h2\u003e\u003cp\u003ePublications on robotic rectal cancer surgery from January 1, 2006, to July 22, 2025, were retrieved from the Web of Science Core Collection (WoSCC) using the search: TI = (\"robotic surgery\" OR related terms) AND TS = (\"rectal cancer\" OR related terms). No restrictions were applied regarding date, language, or publication status.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria and screening strategies\u003c/h3\u003e\n\u003cp\u003eInclusion criteria were: (1) studies on robotic rectal cancer surgery; (2) English language; (3) sourced from WoSCC; (4) publication type as \"articles\" or \"reviews\"; (5) published between January 1, 2006, and July 22, 2025. Exclusion criteria included unrelated topics and non-designated publication types (e.g., abstracts, case reports). All full texts were reviewed, and the corresponding author settled unresolved disagreements. Data were exported in plain text format.\u003c/p\u003e\n\u003ch3\u003eVariables and Analysis\u003c/h3\u003e\n\u003cp\u003eFor each included publication, data on author, country, institution, Journal, and keywords were extracted. VOS viewer (v1.6.20) and CiteSpace (v6.3.1) were used for visualization and analysis. CiteSpace identified keywords with intense citation bursts to explore research frontiers in robotic rectal cancer surgery[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Journal Citation Reports (JCR) and 2025 impact factors (IF) were included to assess scientific value.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eAnnual growth trend of publications on robotic rectal cancer surgery\u003c/h2\u003e\u003cp\u003eFrom January 1, 2006, to July 22, 2025, 598 publications on robotic rectal cancer surgery were identified, including 498 articles (83.28%) and 100 reviews (16.72%). Supplementary Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e shows the literature search flowchart. Publication trends remained flat until 2021, then rose sharply, peaking in 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).3.2 National and institutional cooperation networks.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe included literature originated from 153 countries and regions (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The top five contributors were the United States (n\u0026thinsp;=\u0026thinsp;137), Japan (n\u0026thinsp;=\u0026thinsp;85), China (n\u0026thinsp;=\u0026thinsp;81), South Korea (n\u0026thinsp;=\u0026thinsp;51), and Germany (n\u0026thinsp;=\u0026thinsp;40) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with six of the top ten countries showing centrality\u0026thinsp;\u0026gt;\u0026thinsp;0.1. The U.S. led in publications and made notable contributions between 2020 and 2025. Among the top 10 most-published papers, four were from Japan, three from the U.S., two from South Korea, and one from Denmark (Supplementary Figure S2). Tokyo University of Medical and Dental Sciences and Tokyo University of Science each published 13 papers; the Cleveland Clinic published 11. The University of Texas had the highest citation count at 1,509 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 10 most prolific countries\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCentrality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLink strength\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCitations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCitation\u003c/p\u003e\u003cp\u003ePer articles\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e44.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJapan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e817\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSouth Korea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2759\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e54.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGermany\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEngland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e41.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItaly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e85.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e22.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNetherlands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 10 most prolific institutions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003einstitution\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ecountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCentrality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCitations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCitation\u003c/p\u003e\u003cp\u003ePer articles\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTokyo Medical \u0026amp; Dental University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJapan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstitute of Science Tokyo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJapan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCleveland Clinic Foundation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKorea University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKorea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e452\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e45.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShizuoka Cancer Center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJapan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e481\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e48.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity of Texas System\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e167.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKorea University Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKorea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity of Copenhagen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDenmark\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKaohsiung Medical University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJapan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e42.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntuitive Surgical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eJournal analysis\u003c/h2\u003e\u003cp\u003ePublications in the field of robotic rectal cancer surgery were distributed in 174 journals. Of the top 10 most frequently published journals, 70% were classified as Q1, 20% as Q2, and 10% as Q4(2. the most published journals were Surgical Endoscopy (n\u0026thinsp;=\u0026thinsp;62), Journal of robotic surgery (n\u0026thinsp;=\u0026thinsp;35), and Diseases of the colon \u0026amp; rectum (n\u0026thinsp;=\u0026thinsp;35) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). the most co-cited Journal was Surgical Endoscopy (2137 citations), followed by Annal of surgery (1245 citations) and Diseases of the colon \u0026amp; rectum (1073 citations) (Supplementary figure S3, Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Nine of the top 10 cited journals were JCR sub-region 1. Jama-Journal of the American Medical Association had the highest impact factor (63.1). The double-stack graph describes the discipline distribution, citation trajectory and the transfer of research centres of academic journals[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. We found that surgical studies were frequently cited by healthcare and medical journals, in addition to clinical surgical journals (Supplementary figure S4).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAuthor analysis\u003c/h3\u003e\n\u003cp\u003eOver the past 19 years, 3217 researchers have contributed to robotic rectal cancer surgery studies (Supplementary Table S2). The most prolific author was Kinugasa Yusuke (19 articles), followed by Shiomi Akio (14), Kagawa Hiroyasu (13), Pigazzi Alessio (10), and Huang Ching-Wen (9), with top contributors from Japan, Singapore, the U.S., and South Korea. Pigazzi had the highest citation count (1958), while Baik Seung Hyuk led in co-citations (199) (Supplementary Figure S5). Citation trajectories peaked in 2014, 2019, and 2020 (Supplementary Figure S6). Research themes are split between perioperative complications and future applications of robotic surgery.\u003c/p\u003e\n\u003ch3\u003eCo-citation reference analysis and timeline\u003c/h3\u003e\n\u003cp\u003eCo-cited literature is defined as publications cited by other authors and considered to represent the knowledge base in a field[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Co-cited articles were divided into seven clusters (Supplementary figure S7). All the clusters were closely related to the topic of our study. The highest-cited article was a publication in the Journal of the American Medical Association (IF\u0026thinsp;=\u0026thinsp;55). The title is \"Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomised Clinical Trial. \"It has been cited 170 times in total[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. he timeline view is a data visualization method that combines clustering and time-slicing techniques to display the trends and interrelationships of research topics over time, while also illustrating the distribution of problems within the field[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The most frequently occurring word in each cluster was identified as the cluster label. We therefore plotted a timeline view of the co-cited literature (Supplementary figure S8). We found that \"Da Vinci robotic surgery study\" and \"large randomized controlled trials\" were the research focus of robotic rectal cancer surgery. \"Learning curve of robotic surgery\" and \"total mesorectal excision\" are new research hotspots. They are developed from the previous further deepening[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The top co-cited reference was the article entitled \"Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomised Clinical Trial\" from The Journal of the American Medical Association (IF\u0026thinsp;=\u0026thinsp;55), which was cited a total of 170 times (Supplementary Table S3).\u003c/p\u003e\u003cp\u003e\u003cb\u003eKeyword co-occurrence, clustering and emergence analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAfter filtering irrelevant terms via CiteSpace, the top five keywords were \"total mesorectal excision,\" \"laparoscopic surgery,\" \"short-term outcomes of robotic rectal cancer surgery,\" \"randomized controlled trials,\" and \"learning curve of robotic rectal cancer surgery\" (Supplementary Table S4). Keyword evolution reflects shifts in research frontiers[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A timeline view revealed 10 clusters, with key themes since 2018 including postoperative complications, mesorectal excision, robotic surgery prospects, randomized trials, learning curves, lateral lymph node dissection, resection quality, and total neoadjuvant therapy (Supplementary Figure S9). Emergent keywords, those with high citation bursts, highlight frontier topics[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Seventeen keywords showed intense bursts from 2006 to 2025 (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), with \"short-term outcome,\" \"experience,\" \"MRC CLASICC trials (Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer Trial),\" and \"survival\" ranking highest. \"Open resection,\" \"risk,\" and \"survival\" remain active hotspots through 2025.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eThe overall development trend of robotic rectal cancer surgery\u003c/h2\u003e\u003cp\u003eThe overall development trend of robotic rectal cancer surgery\u003c/p\u003e\u003cp\u003eTo assess global research trends in robotic rectal cancer surgery, this study conducted the first bibliometric analysis of 19 years of publications from the WoSCC. The analysis revealed growth in publication volume, as well as collaboration networks among countries, institutions, journals, and authors, and frequently cited keywords. Research focus has shifted from \"experience accumulation\" and \"clinical trials\" to \"patient safety\" and \"efficacy.\" Current hotspots include \"survival,\" \"risk,\" and \"open resection.\" This study provides a comprehensive knowledge map to guide future research and clinical practice.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eGlobal Research Contributions\u003c/h2\u003e\u003cp\u003eThis study found that the United States, China, and Japan are leading contributors to robotic rectal cancer surgery research. The U.S. had the highest publication count and citation frequency, while Japanese authors were the most prolific. These trends align with global epidemiological patterns. Surgery remains a primary treatment for rectal cancer, with robotic minimally invasive surgery offering technical advantages over open and laparoscopic methods, especially in confined spaces[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Since FDA approval of the Da Vinci system in 2000, robotic surgery has expanded across multiple specialties[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As the only FDA-approved soft-tissue robotic platform, Da Vinci provides enhanced 3D visualization and instrument flexibility, improving surgical precision[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Robotic rectal cancer surgery represents a long-term direction in surgical innovation, enhancing outcomes and training opportunities. This study systematically analyzed 598 publications from the past 19 years using bibliometric methods[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eStatus quo and optimization path of the institutional and author collaboration model\u003c/h2\u003e\u003cp\u003eUsing CiteSpace and VOS viewer, this study visualised and analysed literature on robotic rectal cancer surgery. The top publishing institutions were Tokyo University of Medical and Dental Sciences, Tokyo University of Science, and Cleveland Clinic\u0026mdash;major cancer centres and comprehensive universities\u0026mdash;highlighting the role of high-level medical research institutions. The institutional cooperation network revealed 72 connections with a density of 0.0522, indicating moderate collaboration but overall limited strength[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Contributing factors include regional disparities, long training cycles, uneven distribution of training centres, and weak interdisciplinary communication. To address this, the study recommends establishing standardized robotic surgery training centres, developing multidisciplinary simulation systems, and promoting skills competitions and collaboration mechanisms[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These efforts could enhance institutional and cross-specialty cooperation, advancing robotic colorectal surgery research and practice[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the author co-map, Kinugasa Yusuke (19 papers), Shiomi Akio (14), and Kagawa Hiroyasu (13) were the most prolific contributors. Academic productivity often correlates with socioeconomic status across countries[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. While some authors formed strong collaborative networks, most cooperation occurred within the same institution or affiliated hospitals, lacking cross-agency, international, and interdisciplinary models[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. To enhance innovation and knowledge sharing, it is recommended to strengthen collaboration, promote multicenter studies, and establish a shared public database for robotic rectal cancer surgery research.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTo analyze the clinical concerns and research focus of robotic rectal cancer surgery from keyword clustering\u003c/b\u003e\u003c/p\u003e\u003cp\u003eKeywords reflect the core themes of research, and co-occurrence clustering maps reveal long-term hotspots and directions in robotic rectal cancer surgery[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. From 2006 to 2025, keyword clustering formed ten groups, with #0 \"Postoperative morbidity\" containing the most terms. Key complications include anastomotic leakage (1\u0026ndash;30% incidence), sexual dysfunction (up to 70% in males), urinary and defecation disorders, infections, and local recurrence[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Robotic surgery offers advantages in precision, reduced bleeding, faster recovery, and better Preservation of urinary and sexual function. However, its impact on postoperative complications needs further validation. While robotic surgery improves surgical quality and lowers recurrence rates, safety concerns and limited patient acceptance remain challenges[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eThe prospects of robotic surgery and the trend of technology integration\u003c/h2\u003e\u003cp\u003eLabel 3 is the future of robotic surgery. The prospects of robotic rectal cancer surgery are extensive, primarily due to the deep integration of artificial intelligence and assistive technology. With the rapid development of artificial intelligence (AI) technology, AI has been gradually applied to preoperative diagnosis, intraoperative navigation and postoperative prognosis evaluation of colorectal cancer. AI combined with a robotic surgery platform can improve surgical accuracy, reduce complications, enable individualized treatment plans, provide intelligent support for diagnosis and treatment at all stages, and elevate minimally invasive treatment to a higher level[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. With the upgrading of technology and the improvement of surgical quality, the robotic surgical system has enhanced the ability to handle the narrow space and complex anatomical structure of the pelvis through high-definition three-dimensional vision, dexterity movement and delicate operation, and achieved safer total mesorectal excision (TME), which makes postoperative functional protection more accurate, reduces bleeding and infection rates, and improves the quality of life of patients. With the expansion of multidisciplinary comprehensive treatment modes, robotic surgery will play a key role in the framework of multidisciplinary combined treatment, such as neoadjuvant chemoradiotherapy, immunotherapy, and targeted therapy, to provide better tumour control and prognosis for patients with locally advanced rectal cancer[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. With the new trend of personalized and minimally invasive surgery, future robotic technology will support more minimally invasive surgical methods, such as single-port surgery and natural orifice surgery, to reduce postoperative trauma and accelerate recovery, and realize real-time navigation and accurate resection by integrating new technologies such as augmented reality (AR) and intraoperative imaging. Despite the apparent advantages of robotic surgery, several issues remain, including high costs, a steep learning curve, and a lack of tactile feedback. Future development should focus on cost reduction, technology popularisation, and improvement of operational experience, combined with an intelligent assistant system, to realise the popularisation and standardisation of surgery[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eKeywords emerged to reveal the trajectory of technological innovation and clinical transformation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn addition to clustering, keyword burst analysis helps identify long-lasting research themes. Time charts and zone maps illustrate the evolution of robotic rectal cancer surgery, highlighting research frontiers and guiding future directions[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Based on 2006\u0026ndash;2025 literature, 17 emergent keywords were identified and grouped into five stages: Initial Exploration (2006\u0026ndash;2010): Focused on feasibility and safety, with keywords like \"experience\" and \"colon,\" reflecting early case accumulation and comparisons with open/laparoscopic surgery[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Evidence Accumulation (2010\u0026ndash;2016): Marked by randomized controlled trials (e.g., \"MRC CLASICC trial\") and growing emphasis on \"short-term outcomes\" and broader \"colorectal surgery.\" Systematic Comparison (2014\u0026ndash;2020): Emergence of meta-analyses and \"conventional laparoscopic surgery\" as a comparator, shifting attention to long-term efficacy and cost-effectiveness[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Functional Preservation (2018\u0026ndash;2023): Research emphasized quality of life, neurological protection, and risk stratification, with keywords like \"survival\" and \"risk,\" aligning with precision medicine. Future Trends (2023\u0026ndash;2025): Reassessment of \"open resection\" for complex cases, and integration of AI and intraoperative navigation, pointing toward personalized, multidisciplinary surgical models[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eFrom dispersion to fusion: the process of knowledge aggregation in robotic surgery research\u003c/h2\u003e\u003cp\u003eThe keyword timeline map reveals a clear evolution in robotic rectal cancer surgery research\u0026mdash;from early technology introduction to quality control. Initial studies (e.g., \"postoperative morbidity,\" \"Da Vinci robot,\" \"mesenteric resection\") focused on feasibility and short-term outcomes. As technology advanced, mid-stage keywords like \"randomised controlled trial,\" \"learning curve,\" and \"lateral lymph node dissection\" reflected a shift toward evidence-based medicine and technical refinement, emphasising surgical training and proficiency[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Recent keywords such as \"resection quality,\" \"inflammatory surgical stress response,\" and \"total mesorectal excision\" highlight growing attention to surgical quality, minimally invasive benefits, and long-term prognosis optimization. Overall, keyword relationships have evolved from scattered to tightly connected, indicating increasing integration and maturity in this research field[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUsing bibliometric methods, this study systematically reviewed 19 years of research on robotic rectal cancer surgery, revealing global patterns, hotspot evolution, and future trends. The field has gradually shifted from technical exploration to quality control and personalized treatment. Despite clear advantages, robotic surgery still faces challenges in multicenter collaboration and technology dissemination, which are essential for broader clinical adoption and standardized development. Limitations of this study include its reliance on the WOSCC, which may result in the omission of relevant studies from other databases. Cooperation networks remain fragmented, with limited transnational and interdisciplinary integration. Additionally, while keyword clustering highlights research hotspots, clinical translation remains underexplored. Future research should expand data sources, enhance collaborative frameworks, and integrate emerging technologies such as AI and intraoperative navigation to advance precision treatment and functional Preservation in robotic surgery.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eData Availability Statement\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request, subject to institutional review board approval and patient privacy considerations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003ethe authors declare no competing interests related to this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003cp\u003eThis study did not involve human participants, animals, or their biological materials, and therefore did not require ethics approval.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003cp\u003eThis study did not involve human participants, and therefore informed consent was not required.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003cp\u003eThis study did not involve human participants or identifiable personal data, and therefore consent to publish was not required.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was supported by the Natural Science Foundation of Hunan Province (2023J60369 [SX], 2022JJ30538 [SX], 2025JJ81067 [XY], 17182025JJ81068 [XC]); the Major Scientific Research Project for High-Level Health Talents in Hunan Province (20230533 [SX], 20231526 [QH]); and the Interdisciplinary Research Program in Medicine and Engineering, The First Affiliated Hospital of University of South China (IRP-M\u0026amp;E-2025-12).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eShi Hao led the study design and manuscript drafting. Wu Wenjie and Hu Hao conducted data collection and analysis. L\u0026uuml; Qiang and Yi Xianhao contributed to literature review and visualization. Huang Qiulin and Chen Xiangheng revised the manuscript and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all researchers and institutions whose work contributed to the bibliometric analysis of robotic rectal cancer surgery. We also acknowledge the patients whose participation in the original studies has advanced the understanding and development of robotic techniques in colorectal surgery.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request, subject to institutional review board approval and patient privacy considerations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSiegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: a cancer journal for clinicians. 2018;68(1):7\u0026ndash;30. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21442\u003c/span\u003e\u003cspan address=\"10.3322/caac.21442\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiegel RL, Miller KD, Jemal A. 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Mini-invasive Surgery. 2020;4(0):2.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Robotic surgery, rectal cancer, bibliometrics, hotspots, trends","lastPublishedDoi":"10.21203/rs.3.rs-7879365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7879365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eRectal cancer is a common digestive malignancy with complex surgical challenges due to pelvic anatomy. Robotic-assisted surgery has gained traction for its superior precision and ergonomics over laparoscopy. This bibliometric analysis of 598 English-language publications (2006\u0026ndash;2025) from the Web of Science explores global research trends. Using CiteSpace and VOS viewer, the study identifies leading contributors (USA, Japan, China), top institutions (Tokyo Medical and Dental University, Tokyo University of Science, Cleveland Clinic), and key authors (Kinugasa, Shiomi, Kagawa). Early studies emphasized technical aspects; recent work focuses on survival, risk stratification, and comparisons with open surgery. The field is shifting toward personalized care, though wider adoption and institutional collaboration remain crucial.\u003c/p\u003e","manuscriptTitle":"Research hotspots and trends of robotic rectal cancer surgery: a bibliometric analysis (2006-2025)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 05:16:58","doi":"10.21203/rs.3.rs-7879365/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-05T17:30:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T15:47:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140525035075749872789046516344706985894","date":"2025-11-01T17:51:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19283824782084481877546873501742537260","date":"2025-11-01T17:49:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T17:31:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155103814136956340497856730995041517715","date":"2025-11-01T17:14:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164011761193500419855846763720813937588","date":"2025-11-01T17:02:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-27T23:14:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-18T17:56:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-18T14:42:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2025-10-16T15:31:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"86dba1c8-3544-4e71-b5e4-c69ebfff5073","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:03:59+00:00","versionOfRecord":{"articleIdentity":"rs-7879365","link":"https://doi.org/10.1007/s11701-025-02981-3","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2025-11-22 15:57:38","publishedOnDateReadable":"November 22nd, 2025"},"versionCreatedAt":"2025-11-10 05:16:58","video":"","vorDoi":"10.1007/s11701-025-02981-3","vorDoiUrl":"https://doi.org/10.1007/s11701-025-02981-3","workflowStages":[]},"version":"v1","identity":"rs-7879365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7879365","identity":"rs-7879365","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}