Initial adaptation and surgical performance of the hinotori™ robotic system among pediatric surgeons with minimal robotic exposure.

Abstract

Purpose: This study aimed to evaluate the ability of the hinotori™ system to mitigate technical and ergonomic challenges in pediatric laparoscopy by comparing usability, suturing precision, and stress responses with that of conventional laparoscopy in a simulated infant abdomen.

Methods: Ten pediatric surgeons with limited robotic experience performed peg transfer and suturing in a 1,400-mL box model simulating a 6-month-old abdomen, using robotic-assisted (Robo) and laparoscopic (Lap) approaches in a crossover design. Performance was assessed using the Fundamentals of Laparoscopic Surgery (FLS) score and the A-Lap Mini platform, which evaluates suturing accuracy across five domains. Physiological stress (heart rate and salivary amylase levels) and subjective fatigue (Chalder Fatigue Scale and visual analog scale) were recorded.

Results: Peg-transfer FLS scores were comparable between Robo and Lap (497.5 vs 531), with progressive improvement across Robo trials. Robotic suturing demonstrated greater air-leak resistance, smaller wound openings, and fewer internal collisions. Stress and fatigue indices did not differ significantly, although trends favored Robo.

Conclusion: Pediatric surgeons with minimal robotic experience achieved higher suturing precision using hinotori™, suggesting intuitive usability and potential safety-related benefits in training. Owing to the small sample size, absence of resident-level validation, and lack of formal performance-stress correlation, confirmation in larger cohorts is warranted.