Trocarless Thoracic Surgery Using the Hinotori Surgical Robot System With a Wound Retractor

The hinotori Surgical Robot System, developed by Medicaroid Corporation, is Japan's first robotic surgical assistant. As of June 1, 2024, it has been approved to be covered by insurance in the field of thoracic surgery in Japan. One of its most notable features is the software-controlled pivot point, eliminating the need for docking between the robotic arms and ports.

To fully leverage this feature, we utilized wound retractors (Lap Protector Mini Mini) at all four port sites instead of inserting trocar sleeves when we introduced the hinotori on January 10, 2025. By July 31, 2025, a total of 14 cases had been successfully completed without any intraoperative complications. Implementing this approach, we confirmed improvements in the efficiency of the roll-in process and effectively controlled bleeding at the port sites. We also enhanced the operability of the stapler, which could be inserted from all ports.

This approach streamlines the complex setup procedures of hinotori and facilitates surgical smoothing. Additional cases and comparative studies with the conventional trocar sleeve method will be necessary to validate its clinical utility.