Annals of Coloproctology

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Minimally invasive surgery

Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System: Koji Morohara, Hidetoshi Katsuno, Tomoyoshi Endo, Kenichi Nakamura, Kazuhiro Matsuo, Kazuki Tsujimura, Tetsuya Koide, Takashi Imanaka, Tomohiro Kubo, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise; Ann Coloproctol. 2026;42(2):237-246. Published online April 15, 2026; DOI: https://doi.org/10.3393/ac.2025.01151.0164

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Purpose
The da Vinci Surgical System has led to major advances in robot-assisted colorectal surgery. Following its patent expiration, domestic alternatives such as the hinotori Surgical Robot System have been developed in Japan. However, clinical comparisons between the hinotori and the da Vinci Xi systems remain limited. This study aimed to compare the short-term outcomes of right-sided colon cancer surgeries performed with either system using propensity score matching.
Methods
This retrospective study included 39 patients who underwent da Vinci–assisted surgery and 37 who underwent surgery using the hinotori system. Propensity score matching was performed using 7 covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, clinical T and N categories, and surgeon experience (≥100 prior robotic colorectal surgeries). To assess the robustness of the findings, inverse probability weighting was also applied using the same covariates. Surgical, postoperative, and pathological outcomes were evaluated.
Results
After matching, 27 patients were included in each group. The hinotori group had significantly longer operative and console times (236 minutes vs. 191 minutes, P=0.001; 140 minutes vs. 90 minutes, P<0.001). No significant differences were observed in blood loss, complication rates, length of hospital stay, or lymph node harvest. No conversions or reoperations occurred. One readmission for ileus was noted in the da Vinci group, whereas none occurred in the hinotori group.
Conclusion
Right colectomy assisted by the hinotori system demonstrated short-term outcomes equivalent to those of the da Vinci system, despite a prolonged operative time. Further prospective studies with larger sample sizes and longer follow-up are warranted.

Citations

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Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef

Minimally invasive surgery

Propensity score–matched comparison of robot-assisted rectal cancer surgery using hinotori and da Vinci: Hidetoshi Katsuno, Koji Morohara, Tomoyoshi Endo, Kenji Kikuchi, Kenichi Nakamura, Kazuhiro Matsuo, Takahiko Higashiguchi, Tetsuya Koide, Hiromi Kanai, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise; Ann Coloproctol. 2025;41(4):310-318. Published online August 25, 2025; DOI: https://doi.org/10.3393/ac.2025.00136.0019

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Graphical Abstract Abstract PDF

Purpose
The hinotori Surgical Robot System (hereafter “hinotori”) is a novel platform for robot-assisted surgery, while the da Vinci Surgical System (“da Vinci”) remains the field standard. This study compared short-term surgical outcomes of rectal cancer surgery between these systems using propensity score–matched analysis.
Methods
A retrospective analysis was conducted of 209 consecutive patients who underwent robot-assisted surgery with the da Vinci and 58 patients with the hinotori system. After 2:1 propensity score matching, 108 da Vinci and 54 hinotori cases were included. Surgical outcomes, including operative time, blood loss, postoperative complications, length of hospital stay, and pathological findings, were compared.
Results
After matching, the baseline demographics were well balanced between groups. The hinotori system was associated with significantly longer operative time (266 minutes vs. 227 minutes, P=0.014) and console time (156 minutes vs. 110 minutes, P=0.001). However, estimated blood loss and postoperative complication rate did not differ significantly. Pathological findings, including the number of lymph nodes retrieved and the incidence of positive surgical margins, were comparable between systems.
Conclusion
In rectal surgery, the hinotori system demonstrates comparable short-term safety outcomes to da Vinci. Despite longer operative times and limited integrated instrumentation, hinotori‐assisted procedures may be feasible in selected patients. Further research should address long-term oncological outcomes and strategies to improve procedural efficiency.

Citations

Citations to this article as recorded by

Learning curve for robot-assisted rectal resection using the hinotori™ surgical robot system: a risk-adjusted cumulative sum analysis in a surgical team without prior robotic surgery experience
Akiyoshi Ikebata, Koji Okabayashi, Kohei Shigeta, Hiroyuki Hazama, Masayo Ogiri, Jae-Hoon Yoo, Yumi Egashira, Ryusuke Amemiya, Shinichi Tsuwano, Shigeo Hayatsu
Journal of Robotic Surgery.2026;[Epub] CrossRef
Beyond multiport DaVinci®: a closer look at less commonly used robotic systems in resectional colorectal surgery
Rahul Bhome, Subash P Vasudevan
Journal of Robotic Surgery.2026;[Epub] CrossRef
Early Clinical Experience With the Hinotori Robotic Surgical System: Comparable Perioperative Outcomes With the da Vinci Platform in Primary Lung Cancer
Yasuaki Kubouchi, Ryota Yasuda, Yuji Nozaka, Wakako Fujiwara, Shinji Matsui, Yugo Tanaka
Asian Journal of Endoscopic Surgery.2026;[Epub] CrossRef
Global Evolution of Robotic Colorectal Surgery: Lessons from Hong Kong’s Innovation and Implementation
Trevor M. Yeung, Justin N. F. Lam, Rossetti H. Y. Lam, Simon S. Ng
Cancers.2026; 18(8): 1259. CrossRef
Comparative study of robot-assisted surgery for right-sided colon cancer: a propensity score–matched analysis of the hinotori Surgical Robot System and the da Vinci Surgical System
Koji Morohara, Hidetoshi Katsuno, Tomoyoshi Endo, Kenichi Nakamura, Kazuhiro Matsuo, Kazuki Tsujimura, Tetsuya Koide, Takashi Imanaka, Tomohiro Kubo, Satoshi Arakawa, Tsunekazu Hanai, Zenichi Morise
Annals of Coloproctology.2026; 42(2): 237. CrossRef
Beyond the era of monopoly to diversity: new horizons in robotic colorectal cancer surgery
Jeonghee Han
Annals of Coloproctology.2026; 42(2): 149. CrossRef
Experience with hinotori^TM, the Japan-made Surgical Robotic System, in the Initial 94 Cases of Colorectal Cancer
Takehito Yamamoto, Yoshiro Itatani, Koya Hida, Hiromitsu Kinoshita, Ryosuke Okamura, Masahiro Maeda, Yu Yoshida, Nobuaki Hoshino, Keiko Kasahara, Hisatsugu Maekawa, Ryuhei Aoyama, Kazutaka Obama
Journal of the Anus, Rectum and Colon.2026; 10(2): 213. CrossRef
Racing toward the future of robot-assisted rectal cancer surgery: a comparative study of hinotori and da Vinci
Sung Uk Bae
Annals of Coloproctology.2025; 41(4): 259. CrossRef

Minimally invasive surgery

Robotic surgery may lead to reduced postoperative inflammatory stress in colon cancer: a propensity score–matched analysis: Eun Ji Park, Gyong Tae Noh, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Byung Soh Min; Ann Coloproctol. 2024;40(6):594-601. Published online December 6, 2024; DOI: https://doi.org/10.3393/ac.2024.00171.0024

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101 Download
7 Web of Science
8 Citations

Abstract PDF Supplementary Material

Purpose
Robot-assisted surgery is readily applied to every type of colorectal surgeries. However, studies showing the safety and feasibility of robotic surgery (RS) have dealt with rectal cancer more than colon cancer. This study aimed to investigate how technical advantages of RS can translate into actual clinical outcomes that represent postoperative systemic response.
Methods
This study retrospectively reviewed consecutive cases in a single tertiary medical center in Korea. Patients with primary colon cancer who underwent curative resection between 2006 and 2012 were included. Propensity score matching was done to adjust baseline patient characteristics (age, sex, body mass index, American Society of Anesthesiologists physical status, tumor profile, pathologic stage, operating surgeon, surgery extent) between open surgery (OS), laparoscopic surgery (LS), and RS groups.
Results
After propensity score matching, there were 66 patients in each group for analysis, and there was no significant differences in baseline patient characteristics. Maximal postoperative leukocyte count was lowest in the RS group and highest in the OS group (P=0.021). Similar results were observed for postoperative neutrophil count (P=0.024). Postoperative prognostic nutritional index was highest in the RS group and lowest in the OS group (P<0.001). The time taken to first flatus and soft diet resumption was longest in the OS group and shortest in the RS group (P=0.001 and P<0.001, respectively). Among all groups, other short-term postoperative outcomes such as hospital stay and complications did not show significant difference, and oncological survival results were similar.
Conclusion
Better postoperative inflammatory indices in the RS group may correlate with their faster recovery of bowel motility and diet resumption compared to LS and OS groups.

Citations

Citations to this article as recorded by

Open, Laparoscopic, and robotic approaches in colorectal surgery: a comprehensive review with focus on colorectal cancer
Farhad Shafiei, Fatemeh Kani, Nargess Porkar, Maede Mirzaee, Fatemeh Heidarzadeh, Mahdi Kolivand, Soheila Behdad, Amir Shokri
Journal of Robotic Surgery.2026;[Epub] CrossRef
Impact of Preoperative Neutrophil Percentage-to-Albumin Ratio (NPAR) on Short-Term Complications and Long-Term Prognosis in Patients Undergoing Robot-Assisted Laparoscopic Radical Surgery for Colorectal Cancer
Jing Wang, Tao Hu, Nanhui Yu
Journal of Inflammation Research.2026; Volume 19: 1. CrossRef
Learning curve for Da Vinci Single-Port robotic colorectal cancer surgery: impact of prior robotic experience
Soo Young Lee, Chang Hyun Kim, Jaram Lee, Hyeung-min Park, Hyeong Rok Kim
Surgical Endoscopy.2026;[Epub] CrossRef
Übergangsphase zur roboterassistierten Chirurgie beim kolorektalen Karzinom: eine vergleichende konsekutive Kohortenstudie
U. A. Dietz, M. Kalisvaart, S. Maksimovic, R. Frey, M. Ramser, B. M. Erhart, U. Pfefferkorn
Die Chirurgie.2025; 96(11): 942. CrossRef
Comparative clinical efficacy of three surgical modalities for the treatment of malignant tumours of the left hemicolon
Hao Chen, Dong-Ping Han, Jian-Yang Xiong, Zhen-Sheng Li, Teng-Cheng Hu, Zheng-Rong Li, Yi Cao
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Comparison of the perioperative outcomes of robotic vs. open distal pancreatectomy: a meta-analysis of propensity-score-matched studies
Junjie Wang, Yuanjun Liu, Yakun Wu
Frontiers in Surgery.2025;[Epub] CrossRef
Effectiveness of Guardix-SG in Preventing Postoperative Bowel Complications After Radical Cystectomy: A Single-Arm Prospective Observational Study
Jiwoong Yu, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Seong Il Seo, Seong Soo Jeon, Byong Chang Jeong
Journal of Urologic Oncology.2025; 23(3): 253. CrossRef
Laparoscopic surgery should be a viable option for T4 colon cancer: evidence from a propensity score matching analysis
Xiaomei Jiang, Hang Zhou, Zhaoyang Zheng, Xiaodong Wang, Zongguang Zhou, Lie Yang
Updates in Surgery.2025;[Epub] CrossRef

Colorectal cancer

Partial mesorectal excision can be a primary option for middle rectal cancer: a propensity score–matched retrospective analysis: Ee Jin Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2024;40(3):253-267. Published online March 31, 2023; DOI: https://doi.org/10.3393/ac.2022.00689.0098

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2 Web of Science
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Abstract PDF

Purpose
Although partial mesorectal excision (PME) and total mesorectal excision (TME) is primarily indicated for the upper and lower rectal cancer, respectively, few studies have evaluated whether PME or TME is more optimal for middle rectal cancer.
Methods
This study included 671 patients with middle and upper rectal cancer who underwent robot-assisted PME or TME. The 2 groups were optimized by propensity score matching of sex, age, clinical stage, tumor location, and neoadjuvant treatment.
Results
Complete mesorectal excision was achieved in 617 of 671 patients (92.0%), without showing a difference between the PME and TME groups. Local recurrence rate (5.3% vs. 4.3%, P>0.999) and systemic recurrence rate (8.5% vs. 16.0%, P=0.181) also did not differ between the 2 groups, in patients with middle and upper rectal cancer. The 5-year disease-free survival (81.4% vs. 74.0%, P=0.537) and overall survival (88.0% vs. 81.1%, P=0.847) also did not differ between the PME and TME groups, confined to middle rectal cancer. Moreover, 5-year recurrence and survival rates were not affected by distal resection margins of 2 cm (P=0.112) to 4 cm (P>0.999), regardless of pathological stages. Postoperative complication rate was higher in the TME than in the PME group (21.4% vs. 14.5%, P=0.027). Incontinence was independently associated with TME (odds ratio [OR], 2.009; 95% confidence interval, 1.015–3.975; P=0.045), along with older age (OR, 4.366, P<0.001) and prolonged operation time (OR, 2.196; P=0.500).
Conclusion
PME can be primarily recommended for patients with middle rectal cancer with lower margin of >5 cm from the anal verge.

Citations

Citations to this article as recorded by

Review of definition and treatment of upper rectal cancer
Elias Karam, Fabien Fredon, Yassine Eid, Olivier Muller, Marie Besson, Nicolas Michot, Urs Giger-Pabst, Arnaud Alves, Mehdi Ouaissi
Surgical Oncology.2024; 57: 102145. CrossRef
Tumour-specific mesorectal excision for rectal cancer: Systematic review and meta-analysis of oncological and functional outcomes
Fabio Carbone, Wanda Petz, Simona Borin, Emilio Bertani, Stefano de Pascale, Maria Giulia Zampino, Uberto Fumagalli Romario
European Journal of Surgical Oncology.2023; 49(11): 107069. CrossRef

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