Annals of Coloproctology

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Original Article

Minimally invasive surgery

Propensity score–matched comparison of robot-assisted rectal cancer surgery using hinotori and da Vinci: Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Hiromi Kanai, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise; Ann Coloproctol. 2025;41(4):310-318. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00136.0019

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Purpose
The hinotori Surgical Robot System (hereafter “hinotori”) is a novel platform for robot-assisted surgery, while the da Vinci Surgical System (“da Vinci”) remains the field standard. This study compared short-term surgical outcomes of rectal cancer surgery between these systems using propensity score–matched analysis.
Methods
A retrospective analysis was conducted of 209 consecutive patients who underwent robot-assisted surgery with the da Vinci and 58 patients with the hinotori system. After 2:1 propensity score matching, 108 da Vinci and 54 hinotori cases were included. Surgical outcomes, including operative time, blood loss, postoperative complications, length of hospital stay, and pathological findings, were compared.
Results
After matching, the baseline demographics were well balanced between groups. The hinotori system was associated with significantly longer operative time (266 minutes vs. 227 minutes, P=0.014) and console time (156 minutes vs. 110 minutes, P=0.001). However, estimated blood loss and postoperative complication rate did not differ significantly. Pathological findings, including the number of lymph nodes retrieved and the incidence of positive surgical margins, were comparable between systems.
Conclusion
In rectal surgery, the hinotori system demonstrates comparable short-term safety outcomes to da Vinci. Despite longer operative times and limited integrated instrumentation, hinotori‐assisted procedures may be feasible in selected patients. Further research should address long-term oncological outcomes and strategies to improve procedural efficiency.

Citations

Citations to this article as recorded by

Learning curve for robot-assisted rectal resection using the hinotori™ surgical robot system: a risk-adjusted cumulative sum analysis in a surgical team without prior robotic surgery experience
Akiyoshi Ikebata, Koji Okabayashi, Kohei Shigeta, Hiroyuki Hazama, Masayo Ogiri, Jae-Hoon Yoo, Yumi Egashira, Ryusuke Amemiya, Shinichi Tsuwano, Shigeo Hayatsu
Journal of Robotic Surgery.2026;[Epub] CrossRef
Beyond multiport DaVinci®: a closer look at less commonly used robotic systems in resectional colorectal surgery
Rahul Bhome, Subash P Vasudevan
Journal of Robotic Surgery.2026;[Epub] CrossRef
Early Clinical Experience With the Hinotori Robotic Surgical System: Comparable Perioperative Outcomes With the da Vinci Platform in Primary Lung Cancer
Yasuaki Kubouchi, Ryota Yasuda, Yuji Nozaka, Wakako Fujiwara, Shinji Matsui, Yugo Tanaka
Asian Journal of Endoscopic Surgery.2026;[Epub] CrossRef
Global Evolution of Robotic Colorectal Surgery: Lessons from Hong Kong’s Innovation and Implementation
Trevor M. Yeung, Justin N. F. Lam, Rossetti H. Y. Lam, Simon S. Ng
Cancers.2026; 18(8): 1259. CrossRef
Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System
Koji Morohara, Hidetoshi Katsuno, Tomoyoshi Endo, Kenichi Nakamura, Kazuhiro Matsuo, Kazuki Tsujimura, Tetsuya Koide, Takashi Imanaka, Tomohiro Kubo, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise
Annals of Coloproctology.2026; 42(2): 237. CrossRef
Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef
Experience with hinotori^TM, the Japan-made Surgical Robotic System, in the Initial 94 Cases of Colorectal Cancer
Takehito Yamamoto, Yoshiro Itatani, Koya Hida, Hiromitsu Kinoshita, Ryosuke Okamura, Masahiro Maeda, Yu Yoshida, Nobuaki Hoshino, Keiko Kasahara, Hisatsugu Maekawa, Ryuhei Aoyama, Kazutaka Obama
Journal of the Anus, Rectum and Colon.2026; 10(2): 213. CrossRef
Racing toward the future of robot-assisted rectal cancer surgery: a comparative study of hinotori and da Vinci
Sung Uk Bae
Annals of Coloproctology.2025; 41(4): 259. CrossRef

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