Early Clinical Experience With the Hinotori Robotic Surgical System: Comparable Perioperative Outcomes With the da Vinci Platform in Primary Lung Cancer

INTRODUCTION: The hinotori robotic surgical system, developed in Japan, was first employed for thoracic surgery in 2024 as a domestically produced alternative to the da Vinci platform. However, comparative evidence regarding the clinical performance of this system during the early implementation phase remains limited. Therefore, this study was conducted to investigate the safety, feasibility, and early clinical outcomes of the hinotori system compared with those of the da Vinci system in robot-assisted thoracic surgery (RATS) for primary lung cancer. METHODS: We retrospectively reviewed 77 consecutive patients who underwent RATS at Tottori University Hospital between December 2024 and June 2025, including 21 patients who underwent surgery using the hinotori system (h-RATS group) and 56 patients who underwent surgery using the da Vinci system (d-RATS group). RESULTS: Baseline characteristics were comparable between both groups. Median operative and console times were similar between the groups (145.5 vs. 152.0 min, p = 0.710; 105 vs. 100 min, p = 0.954, respectively). Docking time was significantly longer in the h-RATS group (21 vs. 15 min, p < 0.001) but improved with experience, decreasing from 24 to 18.5 min (p = 0.034). Blood loss, chest tube duration, hospital stay, or postoperative complication rates were also comparable between the groups. No conversion to thoracotomy or postoperative mortality occurred in the h-RATS group. CONCLUSION: These findings suggested that even during its early implementation phase, the hinotori system can be safely and effectively applied in thoracic surgery, achieving perioperative outcomes equivalent to those obtained from the da Vinci system.