A Comparative Analysis of the Hinotori and da Vinci Robotic Systems in Total Hysterectomy for Benign Uterine Gynecological Diseases Using Propensity Score Matching

INTRODUCTION: The hinotori surgical robot system, the first Japanese-made robotic-assisted surgical system to receive Japanese regulatory approval in 2020, is now being applied clinically in gynecology. This study aimed to comprehensively compare the hinotori and the da Vinci Xi Surgical System with respect to safety and surgical outcomes in robot-assisted total hysterectomy for benign uterine gynecological diseases. METHODS: This retrospective observational study used 1:1 propensity score matching (PSM) to review patients who underwent robot-assisted total hysterectomy for benign uterine gynecological diseases at our hospital from August 2020 to June 2025. The hinotori was used in 40 patients, while the da Vinci was used for 187 patients. The primary endpoint was the incidence of complications of Grades I-V according to the Clavien-Dindo (CD) classification system within 30 days postoperatively. RESULTS: After PSM, 40 patients from each group were included in the analysis. Patient characteristics were well balanced between the groups. Complication rates for CD Grades I-V were 7.5% in the hinotori group and 10.0% in the da Vinci group, with no significant difference (p = 0.602). Meanwhile, operative time (144 vs. 118 min, p < 0.001) and console time (113 vs. 76 min, p < 0.001) were significantly longer in the hinotori group. CONCLUSION: In robot-assisted total hysterectomy for benign uterine gynecological diseases, the hinotori and da Vinci were comparable in terms of complication incidence. However, longer operative and console times were observed with hinotori, possibly reflecting early adoption effects or platform-specific factors.