Feasibility of the hinotori™ surgical robot system in right colectomy: a propensity score matching study.

Abstract

Background: Robotic surgery, represented by the da Vinci™ system (hereafter da Vinci), has been adopted worldwide owing to its high precision and improved surgical outcomes. After key patents for da Vinci expired, the hinotori™ system (hereafter hinotori), Japan's first domestically developed surgical robot system, was introduced and received clinical approval in November 2022. Although hinotori is introduced as an alternative to da Vinci, its clinical performance in gastrointestinal surgery, particularly in colectomy, remains unclear. This study provided an overview of the surgical techniques for right colectomy using hinotori and retrospectively compared its short-term clinical outcomes with those of da Vinci, post-adjusting for background factors using propensity score matching (PSM).

Methods: Data from 88 consecutive patients who underwent robotic right colectomy at our institute between 2020 and 2024 were retrospectively reviewed. Patients were classified into the hinotori (n = 28) and da Vinci (n = 60) groups. PSM resulted in 26 patients being assigned to each group. Patient demographics, perioperative outcomes, pathological findings, and complication rates were analyzed and compared between the groups. Patients in both groups underwent standardized surgical procedures performed by the same surgeons using intracorporeal anastomosis. Role switching between the assistant and primary surgeon was required for some procedural steps owing to instrumentation limitations of hinotori.

Results: No significant differences were observed in patient demographics between the propensity score-matched groups. Operative (277.5 vs. 242.5 min, p = 0.044) and console (210 vs. 184.5 min, p = 0.047) times were significantly longer in the hinotori group than in the da Vinci group. No significant differences in blood loss, Clavien-Dindo grade III or higher complications, or postoperative hospital stay were found between the groups. Both groups had comparable histopathological outcomes, including lymph node yield and resection margins.

Conclusion: Our findings suggest that perioperative outcomes in robotic right colectomy using hinotori are comparable to those of da Vinci.