Anatomical lung resection using the hinotori surgical robotic system: initial clinical experience with a standardized...

The hinotori™ Surgical Robotic System, the first domestically developed robotic platform in Japan, was approved for thoracic surgery in 2024. Although initial clinical experiences have been reported in other surgical fields, clinical data regarding its application in thoracic surgery remain extremely limited. This study aimed to describe the initial perioperative outcomes and feasibility of anatomical lung resection using the hinotori™ Surgical Robotic System with a standardized multiport approach.

We retrospectively reviewed patients who underwent robotic surgery using the hinotori™ system at our institution between July 2024 and March 2026. During the study period, 106 robotic procedures were performed, including 81 anatomical lung resections. After excluding mediastinal tumor resections, combined procedures, and cases performed using the dual-port robotic approach, 60 patients who underwent anatomical lung resection using a standardized multiport robotic approach were included in the final analysis.

A total of 60 patients were analyzed, including 36 lobectomies and 24 segmentectomies. No intraoperative complications or conversions to video-assisted thoracic surgery or thoracotomy occurred. Postoperative morbidity was observed in 9 patients (15.0%), including Clavien-Dindo grade ≥ III complications in 4 patients (6.7%). There was no operative mortality.

Anatomical lung resection using the hinotori™ Surgical Robotic System with a standardized multiport approach was feasible in this initial, carefully selected cohort. Further comparative studies with larger cohorts are required to determine its relative safety and efficacy compared with established robotic platforms.