Assessing the Efficacy of the Hinotori Robotic System in Prostate Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies.

Prostate cancer remains a major health concern worldwide. Recently, several robotic systems have been introduced for surgical treatment in urology, demonstrating promising results and gaining clinical acceptance. Among these, a surgical robot developed in Japan has become a notable option for robot-assisted procedures. This study aims to evaluate the efficacy and safety of Hinotori robot-assisted radical prostatectomy (h-RARP) in the management of prostate cancer. A systematic review and meta-analysis of observational studies involving adult prostate cancer patients undergoing h-RARP were conducted. Literature searches were performed across PubMed, Embase, the Cochrane Library, Web of Science, and Google Scholar. Study bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Intervention Studies (ROBINS-I) tool and the Newcastle-Ottawa Scale. Meta-analyses were performed with Comprehensive Meta-Analysis software (Biostat, Inc., Englewood, NJ, USA). Twelve studies, including 1,570 patients, were analyzed, of whom 716 underwent h-RARP. Compared to the comparison group undergoing robot-assisted radical prostatectomy (C-RARP), h-RARP was associated with significantly longer console time (mean difference [MD] = 29.17 minutes; 95% confidence interval [CI]: 15.50 to 42.83) and operative time (MD = 24.98 minutes; 95% CI: 7.33 to 42.64). No significant differences were observed in postoperative and oncological outcomes. Lymph node dissection was performed in 31% of cases, and nerve-sparing was achieved in 29.3%. The positive surgical margin rate was 26.8%, while biochemical recurrence at 12 months occurred in 8.6% of h-RARP patients. In summary, while h-RARP appears to involve longer console and operative times compared to the comparison group (C-RARP), further research is required to fully clarify its clinical benefits.