Initial Surgical Outcomes Using the Novel Surgical Robot ‘Hinotori’

Background In Japan, a new surgical support robot, hinotori, was launched in 2019. Like daVinci, it is equipped with four robotic arms and consists of three pieces of equipment: an operation unit, a surgeon’s cockpit, and a vision unit. However, new features such as thinner arms, docking-free design, and ergonomic design have been introduced. Robots-assisted minimam invasive esophagectomy has also been performed with hinotori (hiRAMIE). We have introduced hiRAMIE at our institution and have performed 45 cases. We will review the surgical results and our experience with the introduction of hiRAMIE in order to confirm its safety. Methods Surgery is performed in the supine position, basically with lymph node dissection of the upper, middle, and lower mediastinum. First, the setup of the hiRAMIE is described. Four robotic arms and one assistant port are used to perform the procedure. A vertical roll-in is performed from the right side of the patient’s head to the superior mediastinum. The energy devices, two forceps, are connected to a bipolar generator. hiRAMIE surgical results of 45 cases performed at our department from September 2021 to January 2025 were collected. Results Robotic-assisted surgery was completed without conversion in all patients. Age: 69 years, male ratio: 0.84, NAC procedure ratio: 0.53. Thoracic console time was 245 minutes, operative time was 605 minutes, and blood loss was 100 mL. Short-term outcomes were Clavien-Dindo ≥3: 0.24, recurrent nerve palsy (CD ≥ 2): 0.13, suture failure: 0.13 (all values are median). Conclusion The complication rate and operative time for hinotori RAMIE were acceptable and safe. Hinotori may be a new and less expensive tool for performing RAMIE. We will describe the features and precautions of the new surgical robot” hinotori”, and present our department’s efforts to safely perform hinotori RAMIE.