Transitioning to hinotori™ robotic surgical system: early clinical outcomes and technical insights of a complete...

The advent of novel robotic platforms, like the hinotori™ Robotic Surgical System, introduced in our institution in 2024, has provided an alternative to the widely adopted da Vinci^® Surgical System. Our study aims to investigate the initial outcomes and technical insights with using the hinotori™ for robot-assisted radical prostatectomy (RARP). Consecutive patients undergoing RARP from October 2024 to April 2025 within a single institution were included. A retrospective analysis of baseline characteristics and perioperative data was performed. For this study, the primary endpoint was perioperative safety and feasibility, defined by console time and intraoperative complications. Secondary endpoints included estimated blood loss, length of hospital stay, positive surgical margins, and total setup time trends. Technical insights and workflow considerations were qualitatively described. A total of 50 first initial and consecutive patients undergoing RARP using hinotori™ were analysed. The median age of patients was 69 (IQR: 65-72) years with a median PSA of 6.6 ng/mL (IQR 5.5-8.1). Most patients had EAU intermediate risk prostate cancer (76%). Median setup time was 33 min (IQR 27-39) and median console time was 203.5 min (IQR 185.8-232.0). Estimated blood loss was 150 mL and there were no cases requiring intra- or post-operative transfusion. Positive surgical margin rate was 12%. No Clavien-Dindo grade ≥ III occurred within 30-days. The 3-month continence rate was 82%. The docking-free design of hinotori™ confers a spacious extracorporeal working environment but requires careful setup of pivot points to avoid instrument friction, which may impact precision. To our knowledge, our institution represents the first centre outside Japan to adopt a complete platform switch from the da Vinci^® system to the hinotori™ platform for RARP. Our initial experience suggests that the hinotori™ robotic surgical system is feasible and safe in the short-term perioperative setting. Key technical considerations and workflow adaptations identified in our early experience may serve as a practical reference for other institutions considering a transition from the da Vinci^® system to hinotori™. Studies with longer follow-up and learning curves are warranted to further evaluate clinical outcomes and effectiveness.