ArticleCureus2025
Surgeon-Perceived Difficulty in Robot-Assisted Radical Prostatectomy Using the Hinotori System: A Multicenter Survey Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
Objectives The hinotori™ Surgical Robot System (Medicaroid Corporation, Kobe, Japan) offers advanced capabilities for performing complex urological surgeries. However, despite its growing adoption, limited data are available on surgeons' subjective impressions of its usability and the process of skill acquisition. This study aimed to assess surgeons' perceptions of the difficulty of key surgical steps during robot-assisted radical prostatectomy (RARP) using the hinotori system. Methods We included facilities that perform 20 or more RARP procedures annually using the hinotori system. In November 2024, an anonymous online survey was conducted among urologists at these facilities to collect information on their overall RARP experience and specific experience with the hinotori system. Surgeons used a five-point Likert scale to rate the difficulty of seven surgical steps. Although this approach is unique, several steps, such as bladder neck dissection, nerve sparing, and vesicourethral anastomosis, are also considered technically demanding in studies with other robotic systems. Statistical analyses were performed to assess differences based on experience levels. Results We received 58 survey responses, representing a cumulative experience of over 800 RARP cases performed using the hinotori system. Bladder takedown was perceived as the least difficult step, whereas bladder neck dissection, nerve sparing, vesicourethral anastomosis, and pelvic lymph node dissection were rated as more challenging. Stratification by experience showed that surgeons with 40 or more hinotori RARP cases perceived bladder takedown (p = 0.033), nerve sparing (p = 0.024), and vesicourethral anastomosis (p = 0.001) as being easier. Conclusion Surgeons' prior experience with other robotic systems influenced the perceived difficulty of procedures using the hinotori system, particularly for complex steps such as nerve-sparing and vesicourethral anastomosis.
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