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Katsuno H, Morohara K, Endo T, Chikaishi Y, Kikuchi K, Nakamura K, Matsuo K, Higashiguchi T, Koide T, Hanai T, Morise Z. A new era in surgical oncology: preliminary insights into the hinotori™ surgical robot system's role in rectal surgery using the double bipolar method. World J Surg Oncol 2024; 22:215. [PMID: 39175003 DOI: 10.1186/s12957-024-03499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The da Vinci™ Surgical System, recognized as the leading surgical robotic platform globally, now faces competition from a growing number of new robotic surgical systems. With the expiration of key patents, innovative entrants have emerged, each offering unique features to address limitations and challenges in minimally invasive surgery. The hinotori™ Surgical Robot System (hinotori), developed in Japan and approved for clinical use in November 2022, represents one such entrant. This study demonstrates initial insights into the application of the hinotori in robot-assisted surgeries for patients with rectal neoplasms. METHODS The present study, conducted at a single institution, retrospectively reviewed 28 patients with rectal neoplasms treated with the hinotori from November 2022 to March 2024. The surgical technique involved placing five ports, including one for an assistant, and performing either total or tumor-specific mesorectal excision using the double bipolar method (DBM). The DBM uses two bipolar instruments depending on the situation, typically Maryland bipolar forceps on the right and Fenestrated bipolar forceps on the left, to allow precise dissection, hemostasis, and lymph node dissection. RESULTS The study group comprised 28 patients, half of whom were male. The median age was 62 years and the body mass index stood at 22.1 kg/m2. Distribution of clinical stages included eight at stage I, five at stage II, twelve at stage III, and three at stage IV. The majority, 26 patients (92.9%), underwent anterior resection using a double stapling technique. There were no intraoperative complications or conversions to other surgical approaches. The median operative time and cockpit time were 257 and 148 min, respectively. Blood loss was 15 mL. Postoperative complications were infrequent, with only one patient experiencing transient ileus. A median of 18 lymph nodes was retrieved, and no positive surgical margins were identified. CONCLUSIONS The introduction of the hinotori for rectal neoplasms appears to be safe and feasible, particularly when performed by experienced robotic surgeons. The double bipolar method enabled precise dissection and hemostasis, contributing to minimal blood loss and effective lymph node dissection.
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Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan.
| | - Koji Morohara
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Yuko Chikaishi
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Kazuhiro Matsuo
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Takahiko Higashiguchi
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Tetsuya Koide
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
| | - Tsunekazu Hanai
- Department of Gastrointestinal Surgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Zenichi Morise
- Department of Surgery, Fujita Health University, Okazaki Medical Center, Gotanda 1, Harisaki, Okazaki, Aichi, 444-0827, Japan
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Hamasaki S, Kaneko G, Yabuno A, Miyama Y, Hiruta S, Hagiwara M, Shirotake S, Yasuda M, Oyama M. Robot-Assisted Partial Cystectomy Using the "Double Bipolar Method". Cureus 2024; 16:e61610. [PMID: 38962625 PMCID: PMC11221892 DOI: 10.7759/cureus.61610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
The "double bipolar method" (DBM) in robotic surgery has been widely used in Japanese general surgery and gynecology; however, it is not commonly used in the field of urology. A 55-year-old female was diagnosed with stage IA endometrial cancer. A 2-cm cystic lesion was incidentally observed at the dome of the bladder on magnetic resonance imaging. A simultaneous robot-assisted total hysterectomy and partial cystectomy using the da Vinci Xi system was planned. The gynecological procedure was first performed with the DBM, and the DBM was also used in the partial cystectomy without additional instruments to reduce surgical costs. Maryland bipolar forceps was used to excise the peritoneum, fat, and bladder wall without bleeding, enabling delicate and precise resection using the forceps' tips. Robot-assisted partial cystectomy using the DBM was feasible. When performing combined surgeries with other departments, if the DBM is already being utilized, it is worthwhile to attempt to decrease surgical cost.
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Affiliation(s)
- Shieru Hamasaki
- Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Go Kaneko
- Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Akira Yabuno
- Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Yu Miyama
- Pathology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Shinnosuke Hiruta
- Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Masayuki Hagiwara
- Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Suguru Shirotake
- Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Masanori Yasuda
- Pathology, Saitama Medical University International Medical Center, Hidaka, JPN
| | - Masafumi Oyama
- Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, JPN
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Mise Y, Miyashita M, Yoshioka R, Kawano F, Takeda Y, Ichida H, Saiura A. Introduction of robotic pancreatoduodenectomy following phase 2a IDEAL guidelines. PLoS One 2024; 19:e0302848. [PMID: 38709730 PMCID: PMC11073735 DOI: 10.1371/journal.pone.0302848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/07/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Robotic pancreatoduodenectomy (RPD) is a newly introduced procedure, which is still evolving and lacks standardization. An objective assessment is essential to investigate the feasibility of RPD. The current study aimed to assess our initial ten cases of RPD based on IDEAL (Idea, Development, Exploration, Assessment, and Long-term study) guidelines. METHODS This was a prospective phase 2a study following the IDEAL framework. Ten consecutive cases of RPD performed by two surgeons with expertise in open procedures at a single center were assigned to the study. With objective evaluation, each case was classified into four grades according to the achievements of the procedures. Errors observed in the previous case were used to inform the procedure in the next case. The surgical outcomes of the ten cases were reviewed. RESULTS The median total operation time was 634 min (interquartile range [IQR], 594-668) with a median resection time of 363 min (IQR, 323-428) and reconstruction time of 123 min (IQR, 107-131). The achievement of the whole procedure was graded as A, "successful", in two patients. In two patients, reconstruction was performed with a mini-laparotomy due to extensive pneumoperitoneum, probably caused by insertion of a liver retractor from the xyphoid. Major postoperative complications occurred in two patients. One patient, in whom the jejunal limb was elevated through the Treitz ligament, had a bowel obstruction and needed to undergo re-laparotomy. CONCLUSIONS RPD is feasible when performed by surgeons experienced in open procedures. Specific considerations are needed to safely introduce RPD.
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Affiliation(s)
- Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
| | - Mamiko Miyashita
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
| | - Ryuji Yoshioka
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
| | - Fumihiro Kawano
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
| | - Yoshinori Takeda
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
| | - Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Graduate School of Medicine, Hongo, Tokyo, Japan
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Yamada S, Koga H, Seo S, Ochi T, Shibuya S, Yazaki Y, Takeda M, Fujiwara N, Lane GJ, Yamataka A. Comparison of robotic assistance and laparoscopy for pediatric choledochal cyst: advantages of robotic assistance. Pediatr Surg Int 2023; 40:1. [PMID: 37989795 DOI: 10.1007/s00383-023-05588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
AIM Surgery for pediatric choledochal cyst (CC), complete excision (CE), and Roux-en-Y hepaticojejunostomy anastomosis (HJA) can be performed using laparoscopy (Lap), robotic-assistance (Rob; da Vinci Xi/Si), or both (Lap/Rob). METHODS Lap was used exclusively between 2009 and 2021 (n = 31) and Rob was introduced in 2017 (n = 23). All subjects were matched for age, weight, BMI, and episodes of preoperative pancreatitis. For Rob, the first 15/23 were Lap-CE/Rob-HJA and the last 8/23 were Rob-CE/Rob-HJA. RESULTS Total anastomotic time (TAT), TAT per suture during HJA, and time taken for dissection during CE were significantly shorter with less variance for Rob, although overall operative times were similar. Serum amylase on postoperative days 3, 5, and 7 were significantly higher for Lap. Times taken to ambulate, for return of bowel sounds, and discharge home were all significantly shorter for Rob. All postoperative complications occurred after Lap; HJA leak (n = 1; 3.2%), HJA stricture (n = 1; 3.2%), both treated by open re-HJA; and pancreatic fistula (n = 6; 19%), all treated conservatively. CONCLUSION Dissection and recovery were faster with Rob while overcoming Lap-associated shortcomings to prevent complications associated with suturing. Both CE and HJA were safer and more reliable with Rob, a reflection of Rob's superiority.
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Affiliation(s)
- Shunsuke Yamada
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan.
| | - Shogo Seo
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Souichi Shibuya
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Yuta Yazaki
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Masahiro Takeda
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Naho Fujiwara
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
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Ikoma N, Seo YD, Newhook TE, Maxwell JE, Kim MP, Tran Cao HS, Tzeng CWD, Chun YS, Lee JE, Vauthey JN, Katz MHG. Quality of superior mesenteric and hepatic artery dissection in robotic pancreatoduodenectomy for pancreatic cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:e1-e2. [PMID: 35950790 DOI: 10.1002/jhbp.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 01/17/2023]
Abstract
This video manuscript by Ikoma and colleagues demonstrates their approach to the superior mesenteric artery and hepatic artery periadventitial dissection. The quality of superior mesenteric artery and hepatic artery dissections should be maintained in robotic pancreatoduodenectomy when performed for pancreatic cancer, to provide the best possible oncological outcomes.
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Affiliation(s)
- Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yongwoo D Seo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica E Maxwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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