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Background <p>Robot-assisted minimally invasive esophagectomy (RAMIE) provides superior precision, three-dimensional visualization, and enhanced instrument dexterity compared to conventional approaches. The “Fusion Surgery” concept, which emphasizes dynamic cooperation between console and bedside surgeons, has the potential to improve operative efficiency and facilitate technical skill acquisition. This study used stepwise learning curves in RAMIE to explore the feasibility and initial experience with the da Vinci™ and hinotori™ robotic platforms.</p> Methods <p>We retrospectively analyzed 30 patients with esophageal cancer who underwent RAMIE using the Fusion Surgery approach between June 2024 and November 2025. The first 25 consecutive procedures were performed with the da Vinci system, followed by five with the hinotori system, all by the same surgical team. Thoracic lymphadenectomy was standardized into lower, middle, and upper mediastinal segments. Learning curves were assessed using cumulative sum (CUSUM) analysis of console operation time. Intraoperative blood loss and postoperative hospital stay were evaluated as secondary outcomes.</p> Results <p>The median total console operation time was 210&#xa0;min. Middle mediastinal dissection time was significantly shorter with the hinotori system than with the da Vinci system (46 vs. 76&#xa0;min, <i>p</i> = 0.010), whereas upper and lower mediastinal dissections showed favorable trends. CUSUM analysis demonstrated progressive improvement across all mediastinal levels. Upper mediastinal console time continued to decrease after transition to the hinotori system, middle mediastinal dissection showed marked improvement following the transition, and lower mediastinal dissection exhibited a steady downward trend from the initial cases. These findings indicate cumulative learning and effective transfer of technical skills across robotic platforms.</p> Conclusions <p>The Fusion Surgery approach may support gradual improvement in RAMIE performance across all mediastinal levels. Transitioning from the da Vinci to the hinotori robotic system did not interrupt the learning curve, supporting smooth continuation of surgical proficiency on a new platform. Fusion Surgery may provide a robust and adaptable framework for sustained technical advancement in RAMIE.</p>

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Fusion surgery in robot-assisted esophagectomy: stepwise learning curves across the da Vinci™ and hinotori™ platforms

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月10日

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  • Yuta Sato,
  • Yuji Hatanaka,
  • Yoshihiro Tanaka,
  • Seito Fujibayashi,
  • Noriki Mitsui,
  • Ryoma Yokoi,
  • Takeshi Horaguchi,
  • Keita Matsumoto,
  • Masahiro Fukada,
  • Itaru Yasufuku,
  • Ryuichi Asai,
  • Jesse Yu Tajima,
  • Nobuhisa Matsuhashi

摘要

Background

Robot-assisted minimally invasive esophagectomy (RAMIE) provides superior precision, three-dimensional visualization, and enhanced instrument dexterity compared to conventional approaches. The “Fusion Surgery” concept, which emphasizes dynamic cooperation between console and bedside surgeons, has the potential to improve operative efficiency and facilitate technical skill acquisition. This study used stepwise learning curves in RAMIE to explore the feasibility and initial experience with the da Vinci™ and hinotori™ robotic platforms.

Methods

We retrospectively analyzed 30 patients with esophageal cancer who underwent RAMIE using the Fusion Surgery approach between June 2024 and November 2025. The first 25 consecutive procedures were performed with the da Vinci system, followed by five with the hinotori system, all by the same surgical team. Thoracic lymphadenectomy was standardized into lower, middle, and upper mediastinal segments. Learning curves were assessed using cumulative sum (CUSUM) analysis of console operation time. Intraoperative blood loss and postoperative hospital stay were evaluated as secondary outcomes.

Results

The median total console operation time was 210 min. Middle mediastinal dissection time was significantly shorter with the hinotori system than with the da Vinci system (46 vs. 76 min, p = 0.010), whereas upper and lower mediastinal dissections showed favorable trends. CUSUM analysis demonstrated progressive improvement across all mediastinal levels. Upper mediastinal console time continued to decrease after transition to the hinotori system, middle mediastinal dissection showed marked improvement following the transition, and lower mediastinal dissection exhibited a steady downward trend from the initial cases. These findings indicate cumulative learning and effective transfer of technical skills across robotic platforms.

Conclusions

The Fusion Surgery approach may support gradual improvement in RAMIE performance across all mediastinal levels. Transitioning from the da Vinci to the hinotori robotic system did not interrupt the learning curve, supporting smooth continuation of surgical proficiency on a new platform. Fusion Surgery may provide a robust and adaptable framework for sustained technical advancement in RAMIE.