ISRG Expands SP Indications: A Game Changer in Colorectal Surgery?

Intuitive Surgical’s ISRG second-quarter 2025 update placed a spotlight on the expanding clinical scope of its Single-Port (SP) platform, with colorectal surgery emerging as a key frontier. The company secured 510(k) clearance for transanal local excision and resection, extending SP’s reach beyond urology and into procedures with significant unmet need. This milestone has added to a suite of transabdominal colorectal capabilities, positioning SP as a more versatile tool for surgeons tackling complex anatomical challenges.

Indication expansion is not just incremental; it is central to SP’s adoption curve. Colorectal and thoracic procedures represent sizable procedure volumes where minimally invasive penetration remains limited. By enabling these surgeries through a single-port approach, Intuitive Surgical offers surgeons the potential to reduce patient trauma, improve access in confined spaces, and streamline workflows. The recent rollout of the SP stapler further strengthens the platform’s appeal for colorectal and thoracic use cases, acting as a critical enabler for broader adoption.

Operational data underscores the importance of these advances. SP procedures grew 88% year over year, with Korea leading at 112% and Europe and Japan making steady early progress. Utilization surged 30%, indicating that surgeons are finding more applications per installed system. For a platform with relatively modest system placements, this utilization trend is crucial, signaling that expanded indications are directly translating into higher case volumes.

Strategically, Intuitive Surgical’s bet on broadening SP’s procedural portfolio could unlock a large, underserved market. Colorectal and thoracic surgeries are high-value areas where innovation can drive both clinical differentiation and financial returns. If adoption continues to accelerate, SP’s expanding indications could transform it from a niche offering into a mainstream growth engine, complementing the company’s dominant multiport franchise.

Competition Update

Although ISRG’s expansion in colorectal surgery is encouraging, several other public and private players, including Johnson & Johnson JNJ and Medtronic MDT, are also catering to this segment.

Medtronic’s Hugo RAS system, while not having the same SP-style natural-orifice access, has been evaluated in colorectal cancer surgeries with encouraging results. A comparative study of Hugo vs. laparoscopy in colorectal cancer (109 patients) showed similar oncologic outcomes (R0 resection, lymph node harvest), complication rates, and comparable lengths of hospital stay and conversion rates.

Johnson & Johnson is advancing its colorectal-adjacent tools — the Ethicon 4000 Stapler (with 3D reloads) is approved for open and laparoscopic use, and is planned for future deployment with the Ottava robotic surgical system. This suggests that J&J is positioning Ottava to better support staple-driven colorectal resections.

Intuitive Surgical’s SP currently leads in colorectal indication breadth and access methods (natural orifice + transanal clearance), offering a unique advantage in minimally invasive colorectal surgery. MDT’s Hugo is proving safe and effective in conventional laparoscopic-versus-robotic CRC settings, but lacks the same natural orifice capability. JNJ’s Ottava, along with its advancing stapler technology, is promising but likely still trails in the range of validated colorectal procedures. Intuitive Surgical’s strategic edge lies in its broad indications and regulatory approvals, which align directly with colorectal clinical needs.

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