Evaluating learning curves and robotic skill transfer to hinotori™: CUSUM analysis after complete platform conversion in radical prostatectomy.

INTRODUCTION &

OBJECTIVE

The transference of surgical skills from da Vinci® to hinotori™ robotic surgery system remain limited in the context of radical prostatectomy. The aim of our study was to evaluate the learning curves and operative outcomes of hinotori™ robot-assisted radical prostatectomy (RARP) by experienced transitioning surgeons.

METHODS

A retrospective study of the initial consecutive hinotori™ RARP cases at a high-volume robotic centre was conducted. All transitioning surgeons included in the study stopped using da Vinici entirely. The cumulative sum (CUSUM) analysis was performed on console time at both institutional and surgeon levels. Console time was defined exclusively as active robotic operating time, measured from console engagement (surgeon seated) to console disengagement (surgeon standing), and did not include docking or skin-to-skin time. Collected perioperative variables encompassed patient characteristics, surgical parameters, and postoperative outcomes. The follow-up period was 3 months.

RESULTS

The first 100 consecutive hinotori™ RARPs within a single institution were included. Proficiency discerned by CUSUM analysis was achieved after 45 cases at the institutional level. Among 4 transitioning surgeons, proficiency was achieved after 11, 11, 11 and 9 cases respectively. Institutional median total operative time decreased from 245 (IQR 223− 68) to 220 (IQR 186.5–262.5) minutes (p = 0.019), and median console time decreased from 205 (IQR 188–232) to 185 (IQR 155.5–231) minutes (p = 0.032) after reaching proficiency. No differences were observed in estimated blood loss (EBL), continence rate at 3-month follow-up (82% vs. 84%, p = 0.494), or biochemical recurrence-free survival (96% vs. 100%, p = 0.951). No Clavien–Dindo ≥ Grade III complications occurred in either proficiency or learning phases. Positive surgical margin (PSM) rates (7 (15.6%) vs. 1 (1.8%), p = 0.021) decreased after institutional proficiency was achieved.

CONCLUSION

Surgeons with prior da Vinci® experience rapidly and consistently transferred their robotic skills to the hinotori™ platform. Complication rates remained stable during the learning curve and once proficiency was reached, positive surgical margins rates notably decreased.