Hinotori vs. da Vinci: a multi-institutional study on robot-assisted radical prostatectomy outcomes.

To compare perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) performed using the hinotori Surgical System and the da Vinci Surgical System in a multi-institutional real-world setting. We retrospectively analyzed 2,066 patients who underwent RARP at 13 institutions. To ensure comparability, 1:2 propensity score matching was performed based on baseline clinicopathological variables, resulting in matched cohorts of 273 patients in the hinotori group and 546 in the da Vinci group. Perioperative, functional (urinary continence), and oncological (biochemical recurrence) outcomes were evaluated. Total operative time and console time were longer in the hinotori group than in the da Vinci group. In contrast, estimated blood loss, postoperative complications, and positive surgical margin rates were comparable between the two groups. No significant differences were observed in time to recovery of urinary continence within the first postoperative year or in biochemical recurrence-free survival. The 3-year biochemical recurrence-free survival rates were 96% in the hinotori group and 95% in the da Vinci group. Within the hinotori cohort, console time was significantly shorter in the later period of system adoption, suggesting a learning effect associated with accumulated experience. In this first multi-institutional comparison, hinotori-assisted RARP achieved perioperative, functional, and oncological outcomes comparable to those of the da Vinci, with operative efficiency improving as experience accumulated.