Nationwide Real-World Outcomes of Robot-Assisted Radical Prostatectomy Using the Hinotori Surgical Robot System in Japan.

BACKGROUND

The Hinotori Surgical Robot System is the first domestically developed robotic platform approved in Japan and is increasingly used for robot-assisted radical prostatectomy (RARP). However, nationwide real-world data remain limited. This study evaluated perioperative, oncological, and functional outcomes of Hinotori-assisted RARP to establish pragmatic benchmark data during its diffusion phase.

METHODS

This multicenter retrospective study included consecutive patients who underwent Hinotori-assisted RARP at 24 institutions in Japan, each performing at least 20 procedures between April 2023 and March 2024. Perioperative outcomes, Clavien-Dindo-graded complications, biochemical recurrence-free rates, and urinary continence at 3 and 6 months were assessed descriptively. Exploratory analyses stratified by surgical experience evaluated learning effects.

RESULTS

A total of 962 patients were analyzed. Median operative time was 260 min (IQR, 214-312), console time 193 min (IQR, 153-237), and estimated blood loss 150 mL (IQR, 50-300). Complications occurred in 11.3% of patients, mostly low grade, with no grade V events. The 6-month biochemical recurrence-free rate was 94.5% (95% CI, 92.8%-95.8%). Urinary continence was achieved in 57.7% and 76.4% at 3 and 6 months, respectively. Operative and console times decreased with experience, while blood loss and positive margin rates were similar across strata.

CONCLUSIONS

Hinotori-assisted RARP showed acceptable safety and progressive functional recovery, with preliminary early oncological outcomes. These nationwide data support its safe implementation in routine clinical practice in Japan.