Background: Robot-assisted surgery has become a cornerstone of minimally invasive gynecologic procedures. While the da Vinci system has long dominated the field, new robotic platforms, such as hinotori™ and Hugo™, have recently been introduced, expanding surgical options. However, no previous study has directly compared surgical outcomes across these four systems. This study aimed to evaluate and compare the perioperative outcomes of four robotic systems—da Vinci X, da Vinci Xi, hinotori™, and Hugo™—in total hysterectomies. Methods: We conducted a retrospective analysis of patients who underwent robotic-assisted total hysterectomy at Tottori University Hospital between April 2019 and January 2025. Patients were categorized into four groups based on the robotic system used. Results: Key surgical parameters, including operative time, blood loss, complication rates, and hospital stay, were analyzed. Subgroup analyses were also performed, including comparisons limited to robot-assisted total laparoscopic hysterectomy without lymphadenectomy and the first 10 cases following the introduction of each system. A total of 293 patients were included. No significant differences were observed among the four systems in terms of operative time, blood loss, or complication rates in the overall cohort analysis or the robot-assisted total laparoscopic hysterectomy subgroups. In the early-case subgroup, Hugo showed a significantly shorter pre-console time, while hinotori demonstrated a significantly shorter console time, both compared to Xi. Conclusion: Total hysterectomy can be safely and effectively performed using all four robotic platforms.

Matsuo K, et al. J Gynecol Oncol. 2017 Dec;29:e88. https://doi.org/10.3802/jgo.2018.29.e88

Asai-Sato M, et al. J Gynecol Oncol. 2022 Oct;34:e10. https://doi.org/10.3802/jgo.2023.34.e10

Background This study evaluated the effectiveness of preoperative inflammatory response markers in distinguishing clear cell carcinoma (CCC) and endometrioid carcinoma (EC) from ovarian endometrioma.Methods Patients with stage I ovarian cancer with histology CCC/EC or endometrioma who underwent surgery at our institution between 2010 and 2021 were included. Preoperative inflammatory response markers evaluated were white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, D-dimer, neutrophil/lymphocyte ratio (NLR), platelet count/lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). The tumor markers CA125 and CA19-9 were analyzed. The median values of these markers were compared between the CCC/EC and the endometrioma groups. The areas under the curve (AUC) in Receiver Operating Characteristic analysis were compared.Results Fifty patients with stage I CCC/EC and 247 patients with endometrioma were included in the study. Inflammatory response markers were significantly higher in CCC/EC cases than in endometrioma cases (P < 0.01). Tumor markers demonstrated higher specificity than inflammatory response markers. The AUCs of CRP, ESR, D-dimer, NLR, and SII were significantly higher than those of CA125 and CA19-9 (P < 0.01). The values of NLR, PLR, and SII in four cases of ovarian cancer with preoperative suspected endometrioma were higher than the cut-off value.Conclusion Inflammatory response markers may be useful for the detection of stage I ovarian cancer. Notably, the NLR or SII, calculated using a complete blood count, appears particularly efficient. Combining tumor and inflammatory response markers may enhance diagnostic accuracy in distinguishing ovarian cancer from endometrioma.