ARUS Closing Remarks

Ryoichi Shiroki Japan Speaker Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback. Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms. hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside. DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness. Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology. Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically. In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.

Gang ZhuChina Speaker Enhancing Robotic Surgery with AI and Imaging Navigation: Bridging Precision and EfficiencyBackground: Robotic surgery faces persistent challenges in real-time anatomical navigation during complex procedures like partial nephrectomy (PN), where millimeter-scale precision impacts oncological and functional outcomes. Objective: This review explores the integration of artificial intelligence (AI) and augmented reality (AR)-based holographic imaging to overcome these limitations, synergistically advancing surgical precision and operational efficiency. Design, setting and participants: Holographic imaging, an AR technique reconstructed from CT/MRI via surface rendering, provides detailed 3D anatomical models for preoperative planning, patient counseling, surgical training, and intraoperative navigation. These models enable precise tumor localization, super-selective vascular clamping, and parenchymal preservation, in particular the PN. Results: Clinical outcomes demonstrate significant improvements. AI-automated modeling cuts 3D model reconstruction time while improving segmentation accuracy. AI enhanced holographic imaging in patient consultation, education and training, surgical planning, and surgical navigation have demonstrated value. Holographic imaging navigation overlays virtual models onto endoscopic views, reducing collecting system injury and increasing enucleation rates for endophytic tumors. AI-based holographic imaging visualization alters surgical strategy for complex cases, reducing conversion from partial to radical nephrectomy. Challenges persist in tracking robustness due to intraoperative organ deformation. Future directions include multimodal Integration: Combining holographic imaging and PET CT to define the metastatic lymph nodes, enabling personalized complete resection; Full-Cycle Coverage: Extending from preoperative assessment to postoperative recovery (e.g., recurrence prediction, customized rehabilitation plans); Telesurgery Empowerment: 5G + holographic imaging to support telesurgical guidance, promoting the decentralization of medical resources. Conclusions: AI-powered holographic imaging navigation bridges critical gaps in robotic surgery by transforming static anatomical data into dynamic, real-time guidance. This synergy enhances precision in tumor resection and vascular management while streamlining workflows—ultimately improving patient outcomes through reduced ischemia, fewer complications, and greater nephron preservation, enhancing survival and quality of life for cancer patients. Real-time navigation integrating “anatomy-function-metabolism”, advancing MIS from “precision resection” to “personalized treatment” and "functional preservation”.