Robotic distal pancreatectomy using a novel surgical robot platform “<scp>hinotori™</scp>” (with video)

Abstract

With accompanying video, Ide and colleagues report their first clinical experience using the new Japanese surgical robot hinotori™ for robotic distal pancreatectomy, with favorable short-term surgical results. Their findings suggest that the hinotori™ surgical robot provides a feasible and reproducible surgical procedure for safe and effective robotic distal pancreatectomy. In the field of hepatobiliary-pancreatic surgery, the da Vinci™ Surgical System (Intuitive Surgical Inc., CA) has been the only leader-follower surgical robot.1 While new surgical robot platforms for clinical practice have recently become available,2 no reports have focused on comparing surgical results with the da Vinci™ Surgical System in pancreatectomy. We present our first clinical experience in robotic distal pancreatectomy utilizing a new surgical robot, “hinotori™” (Medicaroid Corporation, Kobe, Japan). The surgical technique involved placing five trocars in the upper abdomen, including one for an assistant (Figure S1a). After placing the patient in the supine position with 10° head up and 5° left side up, the operation unit was rolled from the right side (Figure S1b). The pivot was set using a pivot pointer on each trocar of the robotic arms (Figure S1c). The cockpit surgeon performed all procedures, excluding port placement, using a vessel sealing device and pancreatic transection (Video S1). Fifty-eight consecutive patients underwent robotic distal pancreatectomy (hinotori: n = 11; da Vinci: n = 47) between March 2013 and November 2024 (Table 1). Postoperative pancreatic fistula was observed in 9.1% and 12.8% of the cases in the hinotori and da Vinci groups, respectively. Drain fluid amylase levels on postoperative days 1 and 3 were lower in the hinotori group. The oncological performance was comparable between the hinotori and da Vinci groups. The advantages of the hinotori system over the da Vinci system are as follows: (1) each arm has eight axes, which brings more flexibility and reduces the interference between the arms; (2) it employs a “docking-free” design using a software program, which provides a sufficient working space around the trocars3 (Figure S1d); (3) it is adaptable to any trocar and hopping between trocars is easy, leading to easier stapling for pancreatic transection; (4) it has a lower price, with a comparable maintenance fee2; and (5) it has been reported to be a possible platform for remote surgery.2 Meanwhile, the disadvantages are as follows: (1) it requires a longer setting time; (2) the number of available instrument types is low; (3) the range of joint motion in the instrument is smaller; (4) it tends to lose sight of the instruments on the screen; and (5) the collision alarm is sensitive, which sometimes forces operations to be stopped automatically. Hence, understanding the features of each robotic system is important for establishing a surgical strategy for patients with various conditions. This first clinical series of robotic pancreatectomies using the hinotori system showed favorable short-term surgical results. The hinotori surgical robot provides a feasible and reproducible surgical procedure for the secure performance of robotic distal pancreatectomy. The authors declare no conflicts of interest in association with the present study. Figure S1. Video S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.