Feasibility and Safety of Robotic Para-Aortic Lymphadenectomy Using the hinotori™ Surgical Robot System: A First-in-Human Experience

This case series reports the first cases of para-aortic lymphadenectomy performed using the hinotori™ Surgical Robot System (Medicaroid Corporation, Kobe, Japan), Japan's first domestically developed robotic surgical platform. Three patients with gynecologic malignancies (two endometrial and one ovarian cancer) underwent curative surgery, including total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy. All procedures were completed robotically without conversion or intraoperative complications. Operative time ranged from 461 to 512 minutes, and blood loss from 10 to 50 mL. A total of 9-38 para-aortic lymph nodes (median 26) were retrieved, comparable to yields from laparoscopic or da Vinci®-assisted procedures, confirming oncologic adequacy. Postoperative recovery was uneventful in all cases. These cases demonstrate that para-aortic lymphadenectomy using the hinotori™ system is technically feasible and safe. Expanding its use from well-established pelvic surgery to advanced oncologic procedures marks an important milestone for robotic surgery in Japan. Further studies are needed to refine protocols and assess outcomes.