Robotic distal pancreatectomy using a docking-free system (the hinotoriTM Surgical Robot System)

Background: Although robotic surgery has rapidly spread in pancreatectomy [1], the procedure is performed by the da VinciTM Surgical System (Intuitive Surgical Inc., CA), the most common surgical robot in the world [2]. We herein present our first experience of robotic distal pancreatectomy using a new Japanese surgical robot named the hinotoriTM Surgical Robot System (Medicaroid Corporation, Kobe, Japan).Methods: A 68-year-old man who was found to have the mass lesion in the pancreatic tail in a medical examination. Investigations, including various imaging studies suggested a diagnosis of pancreatic cancer (Fig. 1). The patient was considered for robotic pancreatectomy.Results: Five trocars, including one port for the assistant surgeon, were placed at the upper abdomen. The operation unit was rolled in from the right side (Fig. 2). The patient successfully underwent robotic distal pancreatectomy combined with dissection of the regional lymph nodes using the hinotoriTM system. The cockpit surgeon performed all procedures, excluding port placement, vessel clipping, and transection of the pancreas. There were no unrecoverable device errors in this operation. The total operation time was 473 minutes, and the estimated blood loss was 182 ml. The postoperative course was uneventful, and hospital length of stay was 10 days. Pathological diagnosis was pancreatic cancer, T1N1M0, Stage IIB. Adjuvant chemotherapy using S-1 was administered, and he has survived without recurrence for 3 months after the curative resection.Conclusions: This is the first report of robotic pancreatectomy using the hinotoriTM system, which showed the favorable perioperative results. The accumulation of experience and further studies are required to confirm its clinical benefits.