Racing toward the future of robot-assisted rectal cancer surgery: a comparative study of hinotori and da Vinci

Sung Uk Bae

doi:10.3393/ac.2025.00990.0141

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Editorial Minimally invasive surgery 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):259-261.
DOI: https://doi.org/10.3393/ac.2025.00990.0141
Published online: August 29, 2025

Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

Correspondence to: Sung Uk Bae, MD, PhD Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Korea Email: sabiston0000@hanmail.net

• Received: August 21, 2025 • Accepted: August 21, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Several technical advantages of the da Vinci Surgical System (Intuitive Surgical) over traditional laparoscopic surgery include 3-dimensional (3D) magnified imaging, a surgeon-controlled stable camera system, and advanced instruments that provide 7° of freedom, 180° articulation, 540° rotation, tremor filtration, motion scaling, superior retraction, and fixed third-arm retraction. Moreover, for physicians seeking to refine their minimally invasive techniques, robotic colorectal surgery appears to offer a shorter learning curve compared to laparoscopic surgery [1–3].

Several studies have reported improved clinical outcomes in patients undergoing robotic total mesorectal excision (TME), including lower complication rates, shorter hospital stays, and enhanced quality of life, while maintaining oncologic outcomes comparable to laparoscopic TME [4–6]. The REAL trial demonstrated that robotic surgery was associated with better short-term outcomes and reduced circumferential resection margin (CRM) involvement compared with laparoscopic surgery [7]. In contrast, the ROLARR trial did not show a reduction in conversion to open laparotomy or in CRM positivity [8]. Similarly, the COLRAR trial, a recent multicenter randomized controlled trial conducted by Park et al. [9], reported no significant differences between robotic and laparoscopic groups in rates of complete TME, CRM positivity, or complications. A meta-analysis by Milone et al. [10] comparing the completeness of robotic versus laparoscopic TME in rectal cancer demonstrated a significant advantage in favor of robotic surgery (odds ratio, 1.83; 95% confidence interval, 1.08–3.10; P=0.03). With numerous ongoing studies examining various endpoints, a substantial and growing body of evidence continues to establish robotic surgery as an effective modality in rectal cancer treatment. Robotic surgery has now become one of the standard treatment approaches for rectal cancer.

More than 2 decades after the first robotic rectal resection, the da Vinci platform continues to dominate the field. Recently, however, the development of alternative robotic systems has enabled TME procedures to be performed and documented using non–da Vinci platforms for the first time. The Hugo Robotic-Assisted Surgery System (Medtronic) employs modular arm carts and an open console with 3D visualization and a cloud-based management system, offering distinct ergonomic and workflow advantages. Early studies suggest that the Hugo system’s instrument flexibility and advanced imaging may expand minimally invasive options for tailored colorectal cancer surgery [11]. Likewise, the Versius robotic platform (CMR Surgical) redefines surgeon-console interaction through game-controller style handgrips and an open-architecture design, with the aim of reducing surgeon fatigue and enhancing team communication. Initial clinical series have reported favorable outcomes for Versius in rectal cancer resections, including acceptable operative times, low complication rates, and promising postoperative recovery profiles. Early multicenter trial results further indicate that Versius is both safe and effective, with perioperative outcomes comparable to conventional laparoscopic and robotic techniques [12, 13].

Although the da Vinci system has long dominated robotic rectal surgery, the introduction of the hinotori robotic platform (Medicaroid Corp) has generated increasing attention, particularly in the Asia-Pacific region. Nevertheless, strong comparative data between hinotori and da Vinci systems remain limited. In this context, the present propensity score–matched analysis offers timely and clinically relevant insights into the relative performance of the 2 platforms [14]. The authors deserve recognition for their rigorous comparison of 2 distinct robotic systems using real-world clinical data and robust statistical matching. By applying a propensity score–matched design and evaluating key perioperative and oncologic outcomes, the investigators minimized selection bias and provided a more reliable assessment of the comparative performance of the hinotori and da Vinci systems.

The results indicate that the 2 platforms are largely equivalent in operative time, intraoperative blood loss, conversion rates, and short-term postoperative outcomes. These findings hold particular significance for surgeons and policymakers, especially in Asian countries where the hinotori system is gaining wider adoption. Importantly, there were no significant differences in resection margins or lymph node retrieval, suggesting that the oncologic safety of the hinotori system is comparable to that of the well-established da Vinci.

In conclusion, Katsuno et al. [14] provides important early comparative evidence showing that the hinotori system performs on par with the established da Vinci platform in rectal cancer surgery. These findings not only confirm the clinical feasibility of next-generation robotic systems but also signal the beginning of a new era in which technological diversification may further enhance surgical precision and patient outcomes. As the field advances toward more personalized, minimally invasive solutions, broader adoption of innovative systems such as hinotori is expected to drive continued innovation and refinement in robotic techniques. Accordingly, future multicenter and prospective investigations, including long-term oncologic outcomes, learning curve analyses, and cost-effectiveness studies, will be critical to guiding platform selection and ultimately improving clinical outcomes on a global scale.

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Conflict of interest

Sung Uk Bae is an editorial board member of this journal. No other potential conflict of interest relevant to this article was reported.

Funding

None.

REFERENCES

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8. Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 2017;318:1569–80. Article PubMed PMC
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