Nationwide Real‐World Outcomes of Robot‐Assisted Radical Prostatectomy Using the <scp>Hinotori</scp> Surgical Robot System in Japan

BACKGROUND: The Hinotori Surgical Robot System is the first domestically developed robotic platform approved in Japan and is increasingly used for robot-assisted radical prostatectomy (RARP). However, nationwide real-world data remain limited. This study evaluated perioperative, oncological, and functional outcomes of Hinotori-assisted RARP to establish pragmatic benchmark data during its diffusion phase. METHODS: This multicenter retrospective study included consecutive patients who underwent Hinotori-assisted RARP at 24 institutions in Japan, each performing at least 20 procedures between April 2023 and March 2024. Perioperative outcomes, Clavien-Dindo-graded complications, biochemical recurrence-free rates, and urinary continence at 3 and 6 months were assessed descriptively. Exploratory analyses stratified by surgical experience evaluated learning effects. RESULTS: A total of 962 patients were analyzed. Median operative time was 260 min (IQR, 214-312), console time 193 min (IQR, 153-237), and estimated blood loss 150 mL (IQR, 50-300). Complications occurred in 11.3% of patients, mostly low grade, with no grade V events. The 6-month biochemical recurrence-free rate was 94.5% (95% CI, 92.8%-95.8%). Urinary continence was achieved in 57.7% and 76.4% at 3 and 6 months, respectively. Operative and console times decreased with experience, while blood loss and positive margin rates were similar across strata. CONCLUSIONS: Hinotori-assisted RARP showed acceptable safety and progressive functional recovery, with preliminary early oncological outcomes. These nationwide data support its safe implementation in routine clinical practice in Japan.