My Encounters and Progress with Minimally Invasive Surgery.

After graduating from Juntendo University in 1984, I joined the First Department of Surgery at Juntendo University in 1986 after two years of surgical training. When I started my career as a gastrointestinal surgeon, the only surgical treatment approach was the "open abdominal method", which involves making a large incision in the abdomen. At that time, I did not anticipate the development of new techniques. In the late 1980s, "laparoscopic surgery" using a laparoscope and endoscopic forceps with a small wound through a port was introduced. At our hospital, laparoscopic surgery for cholelithiasis and colorectal cancer was introduced in 1991 and 1993, respectively. Laparoscopic cholecystectomy has rapidly become popular worldwide and has become the gold standard surgical procedure in Japan. With improvements in laparoscopic surgical techniques, laparoscopic surgery for colorectal cancer has evolved into a less invasive technique (reduced port surgery) and more complicated procedure. While one would think there would be no further procedural changes in surgical treatment, another wave emerged, that of robotic surgery. A surgically assisted robotic system was approved by the Food and Drug Administration (FDA) in 2001. In Japan, the use of this system was covered by government insurance in 2012 for prostatectomy. Robotic surgery for prostatectomies was initiated at our hospital in 2013. The use of robotic surgery for colorectal cancer surgery was initiated as a clinical trial in 2015. It was covered by government insurance in 2018, and by Mar. 2025, we had performed approximately 270 robotic surgeries. It has been a great asset and very valuable experience for me to be involved in the launch of two minimally invasive surgical techniques, "laparoscopic surgery" and "robotic surgery," during my 41 years of practice as a surgeon in Juntendo, from the time when only "open surgery" was available.