Comparison of Surgical Outcomes Between the Hinotori and da Vinci Platforms in Robot-Assisted Radical Prostatectomy:...

Comparative evidence between robotic platforms for robot-assisted radical prostatectomy (RARP) remains limited, particularly regarding oncological quality beyond perioperative outcomes. This study compared outcomes between the hinotori and da Vinci systems, focusing on positive surgical margin (PSM) distribution in a real-world cohort with varying surgeon experience.

We reviewed 437 patients who underwent RARP at our institution between 2013 and 2025. After propensity score matching, 130 patients in the da Vinci group and 65 in the hinotori group were analyzed. Perioperative outcomes, PSM rates and anatomical distribution, urinary continence recovery, and biochemical recurrence (BCR)-free survival were compared.

The matched cohort involved 17 surgeons, including 12 hinotori surgeons, with expert surgeons performing 38% of hinotori procedures. Operative, console, and setup-related times were longer, and estimated blood loss was greater in the hinotori group. No transfusions were required. Complication rates and hospital stay were comparable. No differences were observed in overall or stage-specific PSM rates. PSMs most frequently involved the apex and posterolateral regions in both groups, with no difference in anatomical PSM distribution. The 12-month urinary continence recovery rates were 87% in the hinotori group and 85% in the da Vinci group. In the 2-year time-aligned analysis, BCR-free survival rates in the hinotori and da Vinci groups were 94% and 89% at 1 year and 89% and 85% at 2 years, respectively.

Hinotori-assisted RARP showed longer operative and setup-related times but no apparent deterioration in perioperative safety, PSM outcomes including anatomical distribution, continence recovery, or early BCR-free survival.