The advent of novel robotic platforms, such as the Hinotori Robotic Surgical System (HRSS), has disrupted the previous monopoly by da Vinci Surgical System (dVSS). The HRSS was introduced at our institution in 2024 and our current study aims to compare the initial outcomes and technical differences between the HRSS and dVSS for robot-assisted radical prostatectomy (RRP).

Consecutive patients undergoing RRP from July 2024 to Jan 2025 by a single-surgeon were included in our study. Baseline characteristics and peri-operative data such as setup time, console time, estimated blood loss and complications were analysed. Technical insights from using the HRSS were also qualitatively described.

Twenty patients were analysed, including 10 consecutive cases performed with the HRSS and prior 10 historical cases with the dVSS. There were no significant differences in baseline characteristics such as age, serum prostate-specific antigen, clinical tumour stage, and prostate volume.

There were no significant differences in intra-operative or post-operative complications between the two groups. Console time was not significantly different; however, total setup time was 8 minutes longer with HRSS (p=0.031). The docking-free design of HRSS confers advantages of more spacious working extracorporeal environment. However, it required precise setup of the pivot to avoid issues such as instrument friction within the port, which may result in jerky movements or difficulty in exchange of instruments. Adaption of the HRSS appears seamless with no clinically-significant decline in performance for experienced surgeons. Our study confirms the feasibility and safety of HRSS for robot-assisted radical prostatectomy, demonstrating similar peri-operative outcomes to dVSS.