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Medicaroid Hinotori surgical robot deep dive 2025 - It's big in Japan — Transcript

by Steve Bell Surgical Robotics · 12,596 words · 1,999 segments · language en · Watch on YouTube

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0:00Hey, Steve. And welcome to another deep
0:03dive review in surgical robotics. Um
0:06yeah, this week I was able to get down
0:09to the SICO meeting at the Gemelli
0:11Hospital in Rome. And
0:14Hinatori was there
0:16with Medicaroid the Medicaroid team were
0:18there with Hinatori. And I had a chance
0:20to be with the team there.
0:23And on my last video people were saying,
0:27"I would like a much deeper review of
0:29the technology, not just the blah blah
0:31blah
0:32around the companies or whatever." So,
0:35this time I've done a super deep
0:38technical review of the Hinatori.
0:41And Sebastian, the trainer who I used to
0:43work with
0:44a couple of years ago, was there and
0:46he's taken us through every single
0:48detail of the Medicaroid Hinatori. So,
0:51this is a deep dive video and I'm going
0:54to let it be self-explanatory. And then
0:56at the end of it, I'm going to explain
0:59to you in details my thoughts on the
1:02Hinatori system from Japan, from
1:04Medicaroid which is Kawasaki and Sysmex.
1:07And I'm going to give you a deep
1:09my thoughts on on that system and you
1:12know what I what I really think of the
1:14system, what I saw there.
1:16Um yeah, interesting. So, get on with
1:19the review. Go through the whole review.
1:21It's about 40 minutes, but it will give
1:22you every detail about this system. So,
1:26for the techno nerds out there like me,
1:27you should really enjoy this. And
1:29Sebastian did a great job. So, dive in,
1:32enjoy that and then wait till the end
1:33and I'll give you my thoughts and
1:35review.
1:37So, first I need to switch on the
1:41power starts monitor. Because all
1:43devices, if we if we want to to reboot
1:46them
1:47uh simultaneously in the interlink mode
1:50the all devices needs to be have power.
1:52>> Yep. Yeah? And as I promised you, I do
1:55it now here.
1:56>> Yep. A short press. You hear it.
1:59It's blinking.
2:01So, orange blinking means power up.
2:04So, we start.
2:07So, you will see the starting sequence
2:09on this screen. And you will see the
2:11starting sequence also on the surgeon
2:14cockpit. So, and
2:16accordingly, what is the next step?
2:18There will be a self-test like
2:19calibration.
2:20>> Yep. Yeah?
2:22So, let's wait for it.
2:27Let's
2:29It's asking you. So, I tap on yes. And
2:32now come around. Here all the joints,
2:35the brakes, all the kinds for first the
2:38arms will be tested with a self-test.
2:41>> Mhm. So, you will see the arm bases
2:43moving. You hear this snatching. This
2:45are the brakes
2:46>> of of of the system that everything is
2:49not just pulling down.
2:51Simultaneously, here the arm controller
2:54we can see it. They moved up. Oh, you
2:56see it. You see it. They move up a
2:57little bit more into the side. There
2:59will be a snatching. Everything will be
3:01tested simultaneously.
3:04Yeah?
3:06So, it shows you the percentage of
3:08testing. It's a phase. It will re-ask
3:12you to re-perform the self-test. Before
3:15the self-test as usual is not performed,
3:17we can't go into the next mode. You see
3:20the hand controller are going down. So,
3:22all the movements are simulated. Here
3:25you see the arm controller. If they are
3:27just inserting and in removing, the arm
3:32base is moving all the wrist. So, this
3:35is very impressive obvious self-test of
3:38the system.
3:39So, the snatching of the hand controller
3:41just
3:42Yeah, they work here. And at last you
3:45hear again the usual brakes of the arms
3:49tested.
3:52So, 96% almost done.
3:55And then you need to confirm that you
3:58want to continue.
4:01100% successfully.
4:05And
4:06we can start.
4:09Yep. So, draping. Theoretically, we
4:11could go and stand by. On standby for
4:14for different reasons. Anesthesiologist
4:17now calls us or some time delay needs to
4:19be discussed.
4:21It's putting together, reduces the
4:23footprints.
4:23>> Okay.
4:24>> For ready to to cover it with a sterile
4:27cloth.
4:27>> Got it.
4:28>> Yes? Okay. So, theoretically, I will
4:31show you how to drape because this would
4:33this are the drape
4:35>> It would be sterile.
4:36>> The old one. These are the old one. We
4:38have newer one which don't have this
4:39one. So, the drape is over here. This is
4:42the drape adapter as a drape cup Okay.
4:45and with a drape cup in here.
4:47>> single use?
4:48>> Single use. Absolutely single use
4:50because it's it's it went sterile. So,
4:52wait a minute. It looks like this. Uh
4:54okay.
4:54>> It looks like this. Yep. Yeah. So, okay.
4:59Let us just then that we want to drape.
5:01So, I will show you a drape procedure.
5:05Yeah. So, my my my colleague already So,
5:08let's pretend I'm the circulating
5:10>> Yep. nurse for first. I will approach my
5:13height. So, you see here is the end of
5:17end of the joint. So, end of the limit
5:19is reached. But I can go higher in that
5:22case. And also here is the end of reach.
5:25So, I need to go to adapt it a little
5:27bit. Good. So, my colleague or me as um
5:30circulating
5:32I will just put everything into space
5:35that I just don't contaminate anything.
5:38So, let us pretend this is a sterile
5:40table.
5:41So, we have the drape is for the
5:45operation arm. Yeah? So, as usual we
5:48control the exceeded of light, no
5:51damages and then we remove it.
5:54So, you have here a cover
5:57which is showing you front. Front
6:00belongs to here. We also see the cover
6:03for the um for the arm controller
6:06connection port.
6:08Here is the top which has an elasticated
6:10collar.
6:11I prepare it
6:13that it's and I always say it related to
6:16my previous job, make it puffy. Puffy
6:20and very relaxed so that it can fit. You
6:23put it inside. So, you like this. Even
6:26when you contaminate the inside so
6:28nothing happens. Then we just move it
6:32inside let's go here over there.
6:35And here are protectors with that my
6:39gloves can't be contaminated even when
6:41I'm just touching something.
6:43>> Mhm. So, you see that it's still it's
6:46still
6:47protecting my sterility.
6:50And now again
6:52it's always the same. Make it puffy.
6:54Make no tension and that it fits here.
6:58So, this is the new drape where we don't
7:01need these plastic caps. So, I remind
7:03Okay, good. Now, let's pretend that we
7:06all drape the arms. We just remove these
7:08kind of cover. And pay attention because
7:11now you have your unsterile surface. And
7:15we need a sterile Yes, absolutely. So,
7:18let's Yeah, let's take one. So, here is
7:21the sterile drape adapter.
7:24The drape adapter is here.
7:27Good.
7:28Drape adapter protector which is
7:30protecting the inlet, the connection
7:32port of the instrument housing.
7:36You just put it inside.
7:38There's a lever white lever which needs
7:40to be pulled because otherwise you have
7:42no connection port connectivity in that
7:45case. So, you pull it up.
7:47And then you see
7:49everything is in neutral position and
7:51you just put it on. You hear it. Mhm.
7:54Put it down.
7:56And it's done and ready for use.
7:59A draping detection. Got it. Yeah? But
8:03nothing happens because nothing is
8:05attached even
8:07when I'm doing the protector, when I'm
8:09just putting it on and doing this. You
8:12see how it's snatching? It says, "No, I
8:14can't do it on neutral position." So,
8:17the draping
8:18fitting is not sufficient. So, once I
8:21need the drape protector.
8:25So, I just put it on. Yeah?
8:29Tongue is all is is a is pulled because
8:31otherwise you see the white line. And
8:34then I connect it.
8:36Put it on. And I have my draping
8:39picture.
8:40Yes, the happy sound. Yes, yes, the
8:42happy sound. You're right, absolutely.
8:44So, this is And once we have draped this
8:47one, we can
8:48>> Nice. Yeah. So, this is how it functions
8:50to drape. So, we also have the arm base
8:54drape where you can just do it with a
8:56with a unsterile person because the
8:58endings are just covered above.
9:02And it's in the protocol. Yes. One
9:05question, do you have to drape all four
9:07arms for it to work? Yes.
9:09>> Okay. So, you need four connectors and
9:10four to make
9:11>> Yes, absolutely. So, once the sterile
9:13nurse is wrapped, she will do this. So,
9:16it's less than 5 minutes.
9:18>> Yeah, it looks a very fast draping.
9:19>> It's a very fast. So, experienced
9:21Japanese
9:22medical staff from the setup to the
9:25surgery go 25 minutes, maximum 30
9:28minutes. So, one I heard about
9:3120 minutes, but 25 is the moderate time.
9:34Yeah? So, it's an easy approach because
9:36once Hello.
9:38Once I have just done this, my
9:41circulating nurse can put everything
9:43inside. Yeah? Yep. Okay, good.
9:47Yeah. So, but let's do the anatomy.
9:49Okay. The approach, patient is on the
9:52right side. So, we approach patient
9:54left. Yes? Could to patient right also.
9:59And then we have the anatomy. So
10:01thoracic, upper
10:03upper GI, kidney, pelvic, and lower
10:05abdominal for colorectal.
10:07So, we choose the pelvic approach.
10:10So here, the field would be now
10:13left hand.
10:14We have here the sub hand and the
10:16actively but your right hand. So we have
10:19these approach with sub hand on four and
10:22actively working instruments. So, we
10:26have the adjustment now and the next
10:29one, the green obvious button is to roll
10:32in.
10:34We control in with this kind of
10:36footprints because it's a frontal thing
10:38we can hit everything and it's not the
10:40longitudinal approach. So it's it's it's
10:45it's showing to the floor. So, we need
10:47to change the shape by
10:49pressing and I'm just doing something
10:52out
10:53safety feature. It says it's the wrong
10:55way.
10:56We need for first the blue button, the
10:59enable button and then press it to
11:01proceed. You see it's already reducing
11:05with the footprint.
11:07And it's turning into the target anatomy
11:10because we set patient approach from the
11:13left. That means
11:15the arm controller are going directly to
11:17the target. What if somebody's not
11:19seeing the bed or something and it now
11:21touches the bed? I'm sorry? If it
11:23suddenly touches the bed or something
11:25like Yes, something like it hits.
11:27So the system is real is realizing that
11:30that somebody is getting hit. If the
11:32force is very intensively you will have
11:35a response in that case. And it will
11:36stop.
11:37>> But it's not yeah, but it's not so
11:39forceful like that it just pushes you
11:42away. Okay. So it's also um
11:45uh when I work with first assists, so
11:48it's on level one. I could even go down
11:51because of the ceiling but it's okay.
11:53So
11:54now we have the approach. I didn't
11:56confirm that we have the V shape. The
11:59camera needs to be visible that we know
12:01okay, where do we want to go? Do you see
12:04the camera? And we need a reference
12:06point because uh
12:08do I have to go left, right? I don't
12:10know but if we face the entrance of the
12:13endoscope port Okay.
12:15>> This is our target because this is
12:17always the reference points. We do the
12:19pivot point setting with the endoscope
12:21also.
12:22So this is going like a dart plane. Yes,
12:25absolutely. You see
12:27So when I say I accept the position, the
12:30screen turns into uh floor recognition
12:35and it's like a dart plane. Okay.
12:37When I'm here doing nothing, nothing is
12:40happening because I need the throttle
12:42now. Use the throttle and use the blue
12:44button which is called drive switch, not
12:47enable button. So and now you see I have
12:50a guidance. Okay, the park assist. Yes,
12:52the park assist. So I can go like this
12:56or I can just go like that. Yes, so this
13:00is something where you with the three
13:02wheels it's so easy to approach because
13:04you have so smooth maneuvers or
13:07movements like and
13:10the cart doesn't need to be parallel to
13:14the table. Okay.
13:15>> And take it but I'm talking about
13:18slightly angulation. Yes, not about 45°
13:21because then you change your setting in
13:23that case when the
13:24>> perfectly parallel.
13:25>> Absolutely. This is something where we
13:28just bridge. Yeah, so if I'm going
13:31backwards I'll try to save the cable.
13:33Cable management is everything. So you
13:35see it's on three.
13:36So we just approach it and we just I
13:40will show to you now the second. This is
13:43my training's approach for the nurses.
13:45So I'm moving moving and my target is
13:49there.
13:52But if I'm you know Steve, I'm half
13:55Polish and half German. This means
13:57compulsive obsessive
13:59obvious open behavior. I say okay, let's
14:02do a 200 zoom. A fun it. Yes, I'm
14:06matching. I'm on the port. So I'm happy.
14:08But matching the port doesn't mean
14:10exactly in this inside because I told
14:13you about the range of motion is
14:15impressive of the operation unit. So
14:18good. Then we need to talk about these
14:21automatic angulation. We have some
14:23recommendation and references.
14:26So we say okay, because it's an arc
14:28shape. If we go to the arm base
14:31do you agree that
14:33the arm shape the arm base direction is
14:37not really aligned with this arc
14:40uh port placement.
14:42>> Yes. You know that I need for first I
14:45need to adapt it a little bit to my
14:49arc shape. Right.
14:51>> So for this marker needs you please. For
14:54this I will face come here on the side
14:57please. Thank you so much.
15:00Port one and port four and I make
15:02alignments. So that's that's
15:05the marker is holding it that you can
15:07see it obviously because normally you
15:09can do it without.
15:10Here it come, camera.
15:13Um could you face a little bit more to
15:15this? So alignment to this both
15:17fantastic. You see these both ports and
15:19now we might need to do a parallel
15:22matching to this. And then the arm base
15:25turns into the target anatomy which make
15:27it very smooth. I just for obviously
15:29reason. So you use the enable button
15:32again and rotation twisting.
15:35And you see that it's using more
15:38parallel. So you see here. So this is
15:41parallel. Yes, got it.
15:42>> And then we again then we remove it.
15:44Next thing is
15:46do you agree when I'm Thank you so much.
15:50When I'm just having this
15:53shape
15:54yeah?
15:55Uh I'm working more into the dorsal
15:57where area but if I am the arm base and
16:02move forward I have more reach and for
16:06example endopelvic fascia and to to go
16:09to to the rectus space to release
16:12everything that's it that is you just
16:15put your reach more into this
16:17>> want more tilt.
16:18>> Absolutely. And we have a recommendation
16:205% forward. Okay. And last but not least
16:24because we're doing it here, just think
16:26about the ports and think about your
16:29joints. Yes, how far away?
16:31>> Do you Yes, absolutely. And I'm talking
16:34especially about this lateral port. And
16:36I will make it now with an laparoscopic
16:39approach. Do you agree when I'm saying
16:42when I'm the arm base and I'm very far
16:45away I need to stretch my arm to reach
16:47the lateral port. Yes. But if I'm going
16:51more into the left my
16:53my elbow joint is going to better smooth
16:56and I have more reach.
16:58>> Yes. For this we need to put it on the
17:01left side, right? Okay. Okay, very good.
17:06So and we have 5° as a recommendation.
17:10This is a pre-clinical measurement in
17:12that case.
17:13We're at the stage that we are so so
17:15happy to explore to find out what the
17:18system is already to do more. So we we
17:21are figuring it out but as a reference
17:24point we go forward 5%.
17:27You see the arm base is moving. It's
17:29more than so approximately, yeah? So we
17:32don't need to be like 5.0 even when I
17:35when I have done it. And now we go to
17:38the left 5% that we have a very good
17:41approach and no extended elbow joint.
17:45Okay, this is the nice approach
17:48which is is taken within very very
17:51quickly. So I had I had two nurses
17:53yesterday.
17:55I directly have the same explanation and
17:57they could implement this because they
17:58are
17:59laparoscopically and and
18:01robotic experience. So they directly
18:04could understand.
18:05Once we have done it,
18:07we say okay, now
18:09we're
18:11handing over the power from here to
18:14there. And for this we take the mode
18:17prepare the arm.
18:18Press it again.
18:21Enable button.
18:22And you see that the arms are
18:25calibrating
18:26towards the anatomy in front of the
18:29trocars. Yes, and the endoscope arm is
18:34ready to use for the pivot process.
18:37Yes. Once I have done this I accept the
18:40position but I need to double check. You
18:43just come around because I'm
18:45I'm telling the system I'm changing the
18:47power or the influence from side from
18:50here to there and I say okay, we're
18:52ready.
18:53Here it's done. And now we hand over.
18:55Yes, hand over. So as a double check the
18:58safety feature.
19:00So here is the same. Now we start with
19:02the endoscope and should we do the pivot
19:05point setting right Okay, fantastic.
19:07I'll take the camera.
19:09Yes, we have the camera.
19:11Yeah, so and now I told you when we move
19:13the arm it's it's going up, left, right.
19:18When I use the mode switch button it's
19:21going and I need to attach the system.
19:25So this one has a has a weight
19:26approximately about
19:28Oh, 200. Sorry guys. Uh 280. And if you
19:33just feel the weight so
19:35you you just have a resistance but
19:38it's a smooth smooth attachment because
19:42you just attach it. If you just respect
19:44the rate and the rail way. So so you
19:47know absolutely in that case that it's
19:50connected.
19:51Double check. I hear my audio signal,
19:54visual confirmation recognized, and now
19:57I do the two-step pivot point setting
20:00what we did. So, for first at the
20:01surface, second at the muscle fascia.
20:04Here we do a double pivot point pressing
20:08because the skin and the fascia is very
20:10close together. So, once if we don't
20:14have it, we orient it at the port depth
20:16and non-dominant next to the patient.
20:19So, for first I will show, okay, good.
20:21What is my approach? It's the 30 down.
20:23Okay, my target anatomy. I would like to
20:26for first I would like to put it in
20:27space. It's not really aligned, so I
20:31move a lateral movement that I have a
20:33very good approach. And I would just go
20:37a little bit more in the angulation
20:39because we have 30 down approach and
20:41then you turn it in 30 up so that it it
20:43matches, but this is something what is
20:45okay. So, good.
20:48And then I slightly coming to the port
20:51placement and almost touch the port
20:54surface.
20:57Just slightly and press once, press two.
21:01And you see now there is a zero.
21:05As I told you, the zero centimeters
21:08because of the skinny skinny um
21:11tissue.
21:12Okay, and now I'm talking about the
21:14adjustment button because I saw I I
21:16promised you this button will be
21:18definitely explained. Okay, this is
21:20already measured. So, the central
21:23endoscope has measured the pivot point.
21:26But, these arms I don't want to adjust
21:29them manually and put them into space. I
21:31just say, come on. I press the
21:33adjustment button and according to the
21:36calculation of my pivot point setting,
21:39all the arms are going towards the
21:41anatomy and approximately in the same
21:43area where the where the trocars are
21:45aligned.
21:46>> Got it. Absolutely. So, now I'm
21:49attaching it again
21:50because I say, okay, it's inside. Yeah.
21:56Waiting for the recognition. Go inside.
22:00Here's the second measured pivot point
22:02setting, so I did it very very quickly.
22:04So, I put it here at the space.
22:06>> How do you know it's there? So, it's
22:08realized because it has zero. It was
22:11zero centimeters, so it's on the surface
22:13of the skin. So, because of the thin
22:16thin area, right? Okay, you can switch
22:19on the light. Oh,
22:21okay, if it's ready. But but it's okay.
22:24It's a nice light to exchange it with
22:26that we have a
22:27transparent. So,
22:29good panorama view and I always start
22:31with the first one which is next, but
22:34but it's like it's like a dedication or
22:38so, I wouldn't start with this one
22:41because this one is confusing. So,
22:44because for first when you do a pivot
22:47point setting, it measures the distance
22:49between this This could be 26 meters or
22:52something. So, I always start to do one
22:54step after another. The vulnerable place
22:57on the surface of the skin of the
22:58patient and one inside on the muscle
23:02fascia, inside the inside the patient.
23:04So, these are these two pivot
23:07measurements where you just have Yeah,
23:11pressure points. So, how do we do this?
23:14Well, actually nobody likes to do it
23:16with this kind of stuff which is sharp
23:19and pink. For this we have our pivot
23:21pointer.
23:22>> Ah, okay.
23:23>> pointer can be mounted and and easily
23:26like like you did it before with the
23:28Maryland.
23:29It is atraumatic, so we can just touch
23:33it here. So, we just need to attach it a
23:36little bit in a distance, so we just
23:38hold it.
23:40Waiting.
23:42Instrument is being attached. Pivot
23:44pointer is recognized.
23:46Yeah.
23:47So, then we approach. For first we see,
23:51okay, where do we want to go? So, this
23:53is our target. And I always say here is
23:56left, right, here is median. I just put
23:59this port like this. And then I just go
24:02and mimic the port like in this
24:05angulation. So, you can change with the
24:07mode switch indicator you can change the
24:09angulation. Yeah?
24:12From a bigger angle or more lateral
24:15angle. Yeah? Or you can go up, down,
24:20left, and right.
24:22So, let us just say, okay, good. I'm
24:25doing this approach with not such an
24:27angulation. Okay, good. And we go up.
24:31So, you can go inside, touch the surface
24:33with the pivot pointer, press the first
24:36step.
24:37Yes? Okay, so that's the skin setting.
24:39>> This is the skin setting. According to
24:42the thickness of the jaw, yes,
24:46I will press the next one because it's
24:48not really not It's not a thin, but if
24:50the patient is has a high fat tissue,
24:53you need to put the port inside and then
24:56you measure the steps. It's looking here
24:58outside and then you put it inside and
25:01it depends on the body mass index at how
25:04you go into the depth. And then you have
25:06the second pivot point. But when these
25:08pivot point settings, the fulcrum is
25:10measured. Yeah, and everything is
25:13calculated regarding the um
25:15regarding the
25:17the pressure points. So, as I promised
25:19you just Here here's a measurement of
25:219.9. This is absolutely recommendable
25:24because it's within our recommended
25:26distance.
25:27So,
25:29you see here because
25:31the dome is so so thin, it's zero
25:34centimeter. But normally you would have
25:36here eight or six centimeters or four
25:38centimeters depending on the body mass
25:40index alterations. Yeah? So, this is the
25:44pivot point measurement.
25:47Yeah? Good. So, this one is there and
25:50then I do and it's all your preference.
25:52You can now attach your instrument and
25:54put it into space, but I like for first
25:56to do my pivot pivot setting. Then I
25:59have done this topic and then I attach
26:02the instrument. Okay. Yes? So, here
26:04again the same procedure, connecting.
26:08I put this one a little bit in a way
26:10that I have more working space. Looking
26:13inside, trocar distance just like
26:15working zone like this. And you see I
26:18can just approach it from everywhere in
26:20that case where it's comfortable. So, go
26:23here
26:24a little bit more angulation
26:27and then come closer so where you can
26:30just go there.
26:35So,
26:37okay, and press press. So, 10.1. Remove
26:42it.
26:42And last but not least, our sharp hand.
26:45So, where you just would like to do the
26:47retraction of the tool without the drop.
26:50So, here connecting even with the So,
26:53once you are experienced even with the
26:55left hand although I'm a right-hander.
26:58So, dropping the bladder, putting it
27:01here in this direction, so median, and
27:04connecting it like this. So, I put it
27:07here
27:08a little bit more laterally.
27:11So, fantastic.
27:14Going down, approaching,
27:18coming closer. You can do this little
27:20steps if you want to be very very
27:22precise.
27:24And it's done. So, now we adjust the
27:27instruments.
27:29So, the instrument adjustment, let us
27:30just pretend that we need the
27:33the Maryland inside. Just connect it.
27:37Here the sound, confirm. Fantastic.
27:41Now we need to go inside. That doesn't
27:43mean By the way, this blinking doesn't
27:45mean the guide to change because we
27:47didn't exchange something. So, now this
27:49is the step where I inserted it at at at
27:52the surface inside the trocar it will
27:54stop. This is the second measured pivot
27:56point, right?
27:58So, you hear it directly, so it's at at
28:00this stage. Yeah, so I will leave it
28:03like this in in the trocar and
28:05afterwards so let us just do the next
28:09one step by step.
28:10Connecting.
28:13Attaching.
28:15Waiting.
28:18So, you have two different types of
28:20adjusting your instrument. I'm the one
28:23and I'm saying, ah, let's do it
28:25manually. So, this is something what is
28:27really really nice in that case that I
28:29can just follow also uh the um
28:33endoscope, you know? So, this is the
28:36good thing from the point of view of the
28:3930 down 30 up. So,
28:42if I'm still having two needle holder
28:44always the same, just clap on it. If
28:46it's vibrating, you directly know, okay,
28:49just for security reasons. Yeah?
28:52So, I also just put it into space.
28:56And so, here going inside. So, by the
29:00way, it's a laparoscopic approach. When
29:03you use the joystick up, it goes down
29:05like an laparoscopic approach just to
29:08let you know. But you already did it
29:10consciously.
29:12So, the next thing I just I prefer
29:15always to use the both instruments, you
29:17know? So, that I have two on one side
29:20that I can just do the right setting.
29:23So, here a little bit more laterally and
29:27a little bit more up.
29:29So, and last but not least,
29:32we have our wonderful Maryland.
29:36So, on the other side, not inside.
29:40So, we can just go more into the depth.
29:43So, I always just do not
29:45completely the approach that it's over
29:47the target because I like to put it in
29:50space that I can see my instrument for
29:53security reasons and then I do the
29:56precise approach with this fantastic
29:59buttons. Because you know so manually
30:02everything can happen in that case. So I
30:04like to have a space a very good space
30:07for a year.
30:08So go inside and now I'm here. Just look
30:11here I lost view of my instrument. I
30:13love these kind of steps. So you see
30:16three is on 12:00 so I even don't need
30:20to search for it. I know it and now I'm
30:23going more into the depth because I see
30:28a fantastic 3D view.
30:31Go inside a little bit more space and
30:35last but not least my rich oh.
30:38Okay. I'll wait.
30:42I have my retractor which is just
30:45besides besides
30:47good.
30:48So
30:49and it's ready for use for surgical
30:52robots. So
30:53good. The lowest position. Your lowest
30:55profile so you can raise it up to 1.8.
30:59And
31:00we just
31:02just need to move it easy. Yeah? Okay so
31:05it's a manual movement.
31:07>> It's a manual. These are the only two
31:09things at the surgical cockpit which are
31:10manual to move and to adjust the 3D
31:13viewer. Yeah right.
31:15So once you have find your um
31:19final position
31:20put the line up.
31:21Yeah. Yeah people ask me that again can
31:23you get the 3D out?
31:25Yeah yeah. That's interesting the Yes.
31:27>> annotation. The annotation yes
31:29absolutely.
31:31And let's start down with the foot
31:34units. So the foot unit is structured
31:37and we tell you the differences of the
31:39da Vinci and of the of the you know the
31:41system. You need to tap it really tap it
31:44and not to tap it from the side. You
31:45need to push with the or to step on it.
31:49You use this wall pedal to to drive the
31:51sub hands with your active feet first.
31:54Okay. So right sub hand and right
31:56operating hand.
31:57I have a white frame where my foot is
32:00hovering. Left the clutch and scope.
32:03This is a pop up icon which is also
32:05giving you guidance that you know okay
32:08my foot is now there or it's on the
32:11right side when I'm approaching some on
32:14the left side when I'm approaching some
32:16electro-surgical
32:18um
32:18pedals. Yes?
32:20Okay. So once
32:22act not activated you have a white
32:24frame. Activated you have a white
32:27button.
32:28Right? Okay let's get start with the
32:30scope pedal. You see the scope pedal?
32:32The scope pedal is just activated and
32:35you see the horizon indicator. That
32:37means you can tap in also you can zoom
32:40in zoom out and you can like you're
32:43driving a car rotate with your horizon
32:45indicator. Okay. Makes it very easy. You
32:48see the the icon above where the
32:51endoscope all arms are above.
32:54So Marcus could you do me a favor and
32:57just put arm three out of view of the
33:00endoscope. Put it laterally.
33:01>> This one? Yes it should be laterally.
33:04Yes. And now you see a gray arrow. The
33:07gray arrow refers exactly at the clock
33:10where your sub hand or your retractor is
33:13done. So once if you just drop the
33:15bladder and keep it dropped and you work
33:17on the prostate and have no vision it
33:19will be directly displayed at 5:00 4:00
33:22or 6:00. Right?
33:23>> Very interesting. So very very secure.
33:26You have the clutch pedal. The clutch
33:28pedal is activating so you see in the
33:31left the clutch pedal is active and it
33:33disengaged your actively worked
33:35instruments which you have which you
33:37have engaged before.
33:39Clutch pedal
33:40for suturing we have a clutch a clutch
33:43button too but later more.
33:45So good.
33:47Then we have the base unit. Base unit
33:50with communication
33:52where you just hear your stuff. You can
33:55hear it also here but you can hear it
33:57here and the sound.
33:58On the other side you saw the connection
34:00terminal so everything so good. Now
34:03we're coming to the arm units to the
34:06armrest units to be exact. The armrest
34:09units to raise and lower your profile
34:12that you can work with
34:14already known buttons which I already
34:16just showed you. So you can do the
34:18emergency stop reset it.
34:21Okay and here is the adjustment. So I
34:25have presets and I want to have my
34:27presets. Yes please. So I press and hold
34:30so trainer Sebastian it's me. Everything
34:33is just adjusting. The foot unit is
34:35coming out and my armrest is just
34:37adjusting this.
34:39So you can do the presets for 100
34:43adjustments. So it's university hospital
34:46style that enough surgeons can adjust
34:49their own adjustment.
34:51So good. Once we have done this
34:54we are on the home home screen. So you
34:56see here is the
34:58the surgeon cockpit. You see the armrest
35:01the foot unit adjustment. You will do it
35:03afterwards on your own.
35:05And the scaling. The scaling three to
35:08one you know if I do movements of three
35:10here and one will be answered. So this
35:13is something what what brings a little
35:15delay inside the movement. But at the
35:18beginning I always start with with
35:20surgeons who are just coming to the
35:22system getting known with three to one.
35:24Two to one two centimeters here one
35:27centimeter there. So it's always
35:28moderate. So this is more the most
35:30default adjustment. And for quicker
35:33movement 1.5 to one it's almost the
35:35response of of the
35:37of the performance inside the armrest.
35:40Moving bowel so the flexure
35:43bowels mobilization. Yeah just to
35:45release the peritoneum from from a
35:48bigger space.
35:50People distance it was this one what I
35:52showed you. So again you can display it.
35:55You can just exclude it. By the way many
35:57adjustments you can just put it out of
36:00the screen if you don't need it when
36:02you're familiar with this. Okay here the
36:05time measurements for ischemia time for
36:08partial nephrectomy for example. If you
36:11want to start the time you can see it on
36:14the screen and you can definitely so
36:17here you you can start in that case.
36:19Right?
36:20Good.
36:21Okay stop.
36:23So the next what I told you is these
36:25with the different layouts. So you can
36:27just double the screen you can triple
36:29the screen or triple it on the different
36:31style if you just connect some
36:33peripheral devices in that case.
36:35Brightness contra I I won't refer to
36:37this because this is a general
36:39adjustment.
36:40Scope you can turn the scope from 30 up
36:44to 30 down
36:45adjustment. Yeah. So you can do it in
36:48that case.
36:50Yeah.
36:52Hm.
36:53So it turns directly but there is some
36:55easier way without interrupting your
36:57surgical flow that you could you keep
36:59your head in in the headrest.
37:01Because when you're just moving it
37:03inside outside to adjust this one it's
37:06you have interrupted your surgical flow
37:08but later more.
37:10Okay so here the same adjustment like
37:13connected to the to the socket.
37:15This is the error history mode so that
37:17means once I just
37:20put the emergency button and I reset it
37:22it again.
37:24So the next thing is let's go here to
37:27the adjustment adjustment. There are
37:29some appearance thing where I wanted to
37:31get brightness timer. This is here at
37:33the timer. I didn't switch it on. Now
37:35you can see it for the ischemia time.
37:38So it was only here on the display but
37:40there you can for example start start
37:43it. So here are some general adjustment
37:46which are not so not so important. You
37:48can do the bar. You can do the the
37:52instrument bar. You can make it bigger
37:54or smaller.
37:55For training purposes I like to do it
37:58bigger.
37:59So view display. So this is what I'm
38:01saying is where we can switch off all
38:04these kind of of
38:07adjustments.
38:09So for example this is some hand
38:11controller indicator on both sides. It
38:14gives you orientation of your rotational
38:17movement. Especially when you new and
38:20try to do suturing that you say okay
38:23where is my instrument in which position
38:25is it? Is it a neutral position? Then
38:27it's in the middle.
38:28And when I have a white bar that means I
38:31can rotate it 260° in the left and 260°
38:36on the right.
38:37If it's not aligned with my hand
38:40controller there will be a gap and as
38:42you know when there is a gap a movement
38:45is not so smooth and it's restricted. So
38:49you need to put it in neutral position
38:52then you have to
38:53but
38:54we have a guidance in that case before.
38:57So if you just face a rotation yeah on
39:01the end
39:03I will press the clutch pedal and I have
39:06a hand controller action. The system is
39:09already telling you hey please move your
39:12instrument
39:14clockwise to the right position. You see
39:17it here. In that case if I'm going in
39:19the other side it says 360°.
39:23So I'm going backwards. Yes? And now you
39:26see this little gap. So just one sec.
39:30Try to
39:31put the instrument in a good position.
39:35Very good.
39:36So
39:36this. So I put it here.
39:39Yeah and
39:40we do it
39:42again.
39:43You see it and now it's in neutral
39:45position, aligned and I have my full
39:47rotation mode.
39:49So, these kind of steps can be
39:51erased. Just look there and now it's
39:53gone and it's gone. So, these
39:56advisements can be just excluded if you
39:58say, "Okay, it's too much information
40:00for me because I'm already familiar with
40:02this." Yes?
40:04Yeah. And here we adjust instrument
40:06position. This means with the gray arrow
40:08to mean So, if we don't see the
40:11Could you exclude uh Takashi just again?
40:14Could you exclude go laterally with arm
40:17four?
40:18Laterally that it's not visible. Go to
40:20the right.
40:22No, no, not inside. Outside and
40:25Yes, thank you so much. So, again. And
40:27now we're going here and this for
40:29example can be also erased in that case
40:32and then it's gone. So, all these
40:34adjustments can be just excluded for a
40:37experienced surgeon. Yeah. But for
40:39training purposes it's a really nice
40:41thing to tell the surgeon, "Okay, where
40:43am I? How much rotation do I have? Oh,
40:46where is my rotation limited?" Because
40:49in other devices and you know it also,
40:52Steve. We need to
40:54uh pay attention for this alignment of
40:56of the hand controller, yeah, of the
40:58joystick or something. And here you
41:00directly get the information, "Hey,
41:02there's a misalignment this correct."
41:05It's it's uh it's an adjustment which
41:07it's going not to be changed because the
41:09three line my line 3D. Is it Is it HD or
41:134K? It's 4K. It's 4K. Definitely 4K.
41:17It's a Rubina 4K 3D ICG. Okay. Yeah.
41:21It's one of the newer one because the
41:23the pre-last of the Rubina was was uh
41:26Yes, absolutely HD 3D. Absolutely. Okay.
41:29Let me zoom in on that. Yeah, yeah,
41:31yeah. That's please.
41:32I can Wait a minute. Is the stores? If
41:35you
41:36uh
41:37better inside so here. There we go.
41:40>> Yeah.
41:41There you That's right. 4K.
41:44Mhm? 3D. Very nice.
41:46And ICG. Yes. System uh volume, so
41:50general settings. Yeah.
41:53And this device information about yeah,
41:56what kind of model name and software
41:58version. So, everything is just
42:00>> Does the system have an app? A companion
42:02app? Not yet. Not yet. So, this is
42:05something as a trainer is definitely so
42:08on our vision.
42:09>> Okay. Yes.
42:11Yes. So, you mean like like versus app
42:13Like you connect learning sites or
42:15whatever. Yeah.
42:16>> Yeah. Okay. Okay. Good.
42:18So, good. This was the adjustments. The
42:213D viewer, just to emphasize it was we
42:24already had it with the DaVinci 5 before
42:26it was released. So, we had the manual
42:28adjustment where we had to put levers
42:30here the the latches to adjust the
42:34view of the surgeon. And I always refer,
42:37please try to avoid
42:40to go in the uh very famous adjustment.
42:43Try to use an horizontal view where you
42:46have a very good ergonomic position
42:48where the back and the neck is not
42:51strained overstrained. So, you have
42:55a manual you can twist it inside, you
42:57can retrieve it, you can put it inside.
42:59It depends on your adjustment. So, the
43:02levers are manually just um
43:05at at You can change it. The headrest.
43:08I would strongly recommend to use the
43:10headrest because sometimes it can happen
43:12when you're not using the headrest
43:14sufficiently could be like not blurry
43:17because it's very good uh view but but
43:20if something is not so so so clear, put
43:23your head forehead into the headrest.
43:26Yeah, here you have the sensors too
43:28which is engaging and disengaging. You
43:31see a guided workflow to directly first
43:34use matching grips to activate your
43:36instruments.
43:37So, speaker and microphone to
43:39communicate
43:40inside the view. Sony technique, this is
43:43why it's so clear and a 16 to 9 instead
43:47of four Wait a minute. I will help you.
43:49So, now you should see it.
43:52Yeah. A 16 to 9 view
43:55screen instead of 4 to 3. That's This
43:58means when I have DaVinci users I always
44:01say, "Okay, please um
44:02for first be ready for a panorama optic.
44:06Yeah, so the nice high view with a short
44:09right the short the short ending it's
44:13here the opposite really nice panorama
44:15and a very very clear vision. So, these
44:18are the only two things which you do
44:20manually. The other things are just
44:22pressing button, using home screen touch
44:24screens and joysticks.
44:27So, Steve, I think the stage is yours.
44:29Yes, very good. Very good. And now you
44:33see on the screen there is an
44:35information, "Use matching grips. Relax
44:37the grip absolutely. Just close your
44:40close your jaws. Make some rotational
44:42movement and as usual use your
44:44instruments. Just look at the hands in
44:47control indicator of the instruments is
44:49level two. So, we that we start with
44:53this one. Okay. So, do some Yes,
44:55absolutely. Do some endoscope exercises
44:58that you just get away with get in touch
45:01with this experience. You know, it's a
45:03mechanical zooming so the camera is
45:06turning inside and outside. So, um
45:09driving a car if you want to do a
45:11rotational horizon indicator change.
45:14Yes. You I would be now reactive and not
45:18my making too much blah blah now and if
45:20you have questions ask me.
45:22Yes.
45:25Okay. So, if I want to
45:27Yeah.
45:28Go inside the screen again. Yeah, okay.
45:30So, yeah. Okay. So, if you want to take
45:33the instruments in, yes. Use your clutch
45:35pedal the
45:36the small one here. Okay. Yes and come
45:39back with your instruments and go more
45:41into the depth. Release the clutch pedal
45:44and go more into the depth with your
45:45foot. Okay.
45:47What about working in
45:56So, here you can see the
46:01the HF series two. This um makes a
46:04difference because the sterilization
46:06lives. Everyone I told you is 20 lives
46:09except the
46:10a mono class scissors. So, we have the
46:12needle holder for normal needles and for
46:15for uh smooth uh suturing. Then we have
46:18Yeah.
46:19Huh?
46:20And then we have the white needle
46:22holder. The white needle holder is more
46:25designed for a V-Locs, bigger needles to
46:28to handle it.
46:29So, in that case. So,
46:31also 20 lives. So, crossy grasper, it's
46:34a curved fenestrated
46:37for blunt dissection and standard
46:38retracting or or manipulating.
46:42So, we have the universal grasping. You
46:46already recognize it. It's the Cadiere
46:48style. Yeah.
46:51So, also 20 lives.
46:53And here is the VersaTip grasper. So,
46:55the VersaTip grasper you can do or
46:57manipulate tissue but it has a three
47:00time more grasping force.
47:02>> Okay. So, it has a high force grasper.
47:03Yes, absolutely. So, you're willing use
47:05an ultrasound probe to hold it here and
47:08to do some ultrasound diagnostic.
47:11Monopolar scissor. Fantastic. So, 10
47:15lives and I will show you something.
47:17There's a difference with the isolation
47:19cover.
47:19>> Okay.
47:20I do.
47:21I do remember isolation covers.
47:24Yeah, lots of lots of fun with those.
47:25There was much much uh yeah, much much
47:29training practice needed. Sorry.
47:31It's single use as well. So, because
47:34this other one was destroyed. So, I love
47:37it so much because this is so easy to
47:39handle. So, you just have it and you
47:42just squeeze it on side and it's done.
47:47And it's already done.
47:49Yeah, very nice. And you can just remove
47:52it easily. So, you can use this one or
47:55you can use a gauze in that case and
47:57it's done also.
47:58>> Perfect.
47:59>> Yeah.
48:00Yeah. So.
48:02Sorry, I was nervous.
48:05So, I had So, good. Okay, 10 lives. So,
48:09bipolar Maryland.
48:11Yeah. So, many surgeons are just
48:13reporting that the grasping force is
48:16very very impressive.
48:18So, 20 lives.
48:20>> Which generator you do you use?
48:22>> Um so, we use AutoCon. We have a strong
48:25collaboration with Karl Storz. So, the
48:27vision unit is integrated into our Karl
48:30Storz monitor tower. So, it's the the
48:32AutoCon 400. Okay.
48:36So, the bipolar fenestrated also.
48:40Yeah, if somebody don't like this peak
48:42Yeah. um Maryland.
48:46So, and now we have the clip appliers.
48:49So, the standard one which are already
48:50known as Hem-o-lok. So, in in size M, L
48:54and And that's with Weck. Uh absolutely.
48:56We're working close together with Weck.
48:58So, it's easily to adjust 160 ti- 60
49:02lives. Okay. And the little one which is
49:05also from Weck but it's metal. It's the
49:08Horizon in size L. Uh S, sorry. In size
49:11small. Yeah, also from 160 lives.
49:15So, this is our portfolio from
49:19So.
49:36So, the HF series two the news the with
49:39the longest sterilization life, just to
49:41let you know. We will just say there is
49:44no button or something where we have to
49:46press. Surgeon will say we are finished,
49:49we are finished. So, we remove linearly
49:53all the instruments.
50:00So, yeah. We just put it
50:03out.
50:04Yeah, in the linear movement that means
50:07now endoscope control because the guide
50:08to change function.
50:09>> It's interesting that the
50:11the arms reset alone. Absolutely. This
50:13is a very good step. So,
50:20So, now everything is disconnected
50:23disconnected
50:24and now we're going to the screen
50:26because I told you here is the checking
50:28mode. Mhm. Mounting completed. This
50:31signalizes the system arm. Nothing is in
50:33the patient.
50:35So, we can do in the mode bar.
50:38And it he asked because I actively want
50:41to change a position. I say yes.
50:44Yeah? And then a signal is coming.
50:48We need to
50:49to raise the raise the arm base. It goes
50:53automatic up. Yeah, not to impact with
50:56the patient or with anyone else.
50:58It goes backwards. So, no worries. I
51:00just adjusted it very low so the
51:04feeling is not
51:05not interacting. Yes, it goes into a B
51:09position. You see the B?
51:11This is related because the camera needs
51:13to have a clear view. Okay. Okay. And
51:16now you can just look at the screen. We
51:20have here the vision of the camera which
51:22is really nice and really clear.
51:24>> Yeah, that's good.
51:25>> So, for the roll out there is no
51:27guidance because we just need to go
51:28backwards. So, I press the button. I am
51:32you will do it
51:33afterwards. So, go afterwards. So, this
51:35is the speed of two by the way for
51:37training purposes. I can raise the speed
51:39to five. That's very quick by the way.
51:41And if it
51:42if it encounters a cable or a collision
51:45or does it stop? Yeah, so
51:47at this point yeah, at this point it
51:50won't stop because we always recommend
51:52to do it with two persons. Yeah, so
51:54they're circulating and the and the
51:56sterinos when she's already unsterile.
51:59So, as a guidance absolutely. So, even
52:01the roll in we definitely recommend it
52:04because it's a very good a very big
52:06footprint in that case. Yeah.
52:08So, the next thing is
52:10theoretically, if it would be a low
52:12anterior reset, I would turn from the
52:14transversal to the longitudinal approach
52:16and do the anatomy and free roll in.
52:18Okay. A quick step and then it turns
52:21into this longitudinal approach or
52:23transversal approach and I can just
52:26continue. But I say no guy. We need Oh,
52:30yeah. You can put it here inside into
52:32the black one on the
52:33Just put it inside. Okay.
52:35Yeah, and then just switch off the light
52:38at the touch screen. Thank you so much.
52:40So, and but we say no surgery is over.
52:43We want to remove the drapes. I will
52:45show you the draping also.
52:48If you want to sit here. So,
52:51just take here. So, now it's putting it
52:53together
52:56to
52:56the arm base is frontal facing.
53:01And
53:02could you do the table? Could you remove
53:04the table a little bit that it's not in
53:06the way? Yes.
53:13So,
53:14it's frontal. It shows you frontal. So,
53:17for these purposes
53:19it's just frontally shows you the arm
53:21control now.
53:23And I will show you how this draping is
53:25looking like.
53:26So, the height I can raise or lower the
53:29height
53:30without discrimination nurses but I have
53:32very very small nurses colleagues.
53:35So, you can just adapt it to their needs
53:39and you can if you want to drape, you
53:41can already adjust the strength. I will
53:44just remove it.
53:48Disconnect. Remove it. For first pulling
53:51and disconnect.
53:53So, it's a really quick step. So, let us
53:56and I show you the undraping afterwards.
53:58So, disconnect.
54:00Again, single use.
54:02So, I just use like the banana
54:05technique.
54:06So, everything if something is
54:07contaminated, I protect myself and
54:10everything is safe.
54:12Very quickly done.
54:14So, that then you see
54:16the check mark
54:18is gone.
54:20And I tell the system undraping remove
54:22drape completed.
54:24Then I get my legend of all used
54:27instruments. It's not gone when we press
54:30the button Steve. So, it's really
54:32documented.
54:33Current of the surgery, pre-surgery and
54:36the pre-last surgery. For three
54:38surgeries you can see
54:40what kind of type equipment you used,
54:43the serial number and the time
54:45sterilization time used. Got it. Yes.
54:48Okay, good. So, and then you can close
54:50it consciously. Okay, now we go into the
54:53storing position. The good one.
54:56It's literally holding like a Japanese
54:58origami. Okay, let's see that. So, you
55:01will see it. Okay.
55:02Pressing the joystick, it just turns and
55:06it's reducing the
55:07width to its maximum.
55:23So, it's width now it will be at A
55:25shape.
55:27Yeah.
55:28So, it will be in A shape and it will
55:29will
55:30put the arms the operational arms
55:34between the position.
55:36And I can't you see shows the height
55:38adjustment. Now you see the position is
55:40very high.
55:41And you say, "Okay, let's lower the
55:43position that it forward in Japanese
55:46origami Mhm.
55:48to a zero level.
55:51Okay. And now I say I accept the
55:53position.
55:55Storage position completed.
55:58I would
55:59put everything into storing position.
56:02So, let's pretend this one is also So,
56:05in that case
56:06everything is just lowered and put
56:10inside.
56:12Good.
56:13So, you hear the sound the confirmation
56:15sound that just did a different noise.
56:17>> Yeah.
56:18That's if you want to have it lowered,
56:21accept it the the technical advice now.
56:24It's in the lowest profile. It's in the
56:26lowest profile.
56:28And then I can go.
56:30It doesn't matter where I go to the
56:32operation unit.
56:33I can go to the vision unit or I can go
56:36to the surgeon cockpit. Everywhere you
56:38can just do a power it off.
56:40You press longer than 3 seconds. The
56:43system is asking you, "Would you like to
56:46interrupt the shutdown? Cancel the
56:48shutdown?" We say no. And then we are
56:50just waiting.
56:55Good. And it's shutting down
56:57everything.
56:59You see? Now you have a
57:02orange background slides. That means
57:04it's in it's in standby mode but it's
57:07still connected to the power. Also
57:09referring to the both lights of the
57:13wheel brake which is activated and
57:15internal battery.
57:17So, as I told you, we have a
57:19collaboration with our car storage
57:21company. The vision unit is integrated
57:24into the tower. So, I just switch it off
57:27here. Everything is switched off.
57:29And you see if the power is
57:32disconnected,
57:34you have a gray background. Okay. This
57:36is a good thing for troubleshooting. If
57:38it's still gray and you can't stop it,
57:40for example, you want to do a power up
57:43of all systems. It's a short press. It
57:46will directly refer, "Hey, troubleshoot
57:48one of the device which is not orange."
57:51>> Orange. Okay. Yes. Very good.
57:55So, thank you very much for hosting me
57:56this morning.
57:58Um
57:58so, explain who you are and what you do.
58:01So,
58:02first of all like I'm a Kenji Nakajima,
58:04general manager of the Medical of
58:05Europe. We are working on C mark process
58:08in Europe. We are bringing such a kind
58:11of excellent Japanese quality
58:14surgical robot system very soon to be on
58:16the market here in Europe.
58:19Perfect. And you know, so at the moment
58:21if people want to get their hands on cuz
58:24I have a lot of people ask me, "How do I
58:26get a try of Hinotori?" Yeah, try
58:29Hinotori. We had a three site in Europe
58:32in Dusseldorf Medical of Europe office
58:35headquarter. And we had a
58:37one system in OLCI Academy in Belgium.
58:40And the one more system in
58:43Educardo France. If you come to
58:46Educardo Dusseldorf or OLCI Academy, you
58:48can try Hinotori system anytime.
58:51Perfect. And can you give me a little
58:53bit of an update where you are
58:54clinically in Japan? Cuz
58:56it's already in Japan, correct?
58:58>> Yes. Now we had
59:01experience in Japan, Malaysia and
59:03Singapore. And we had a entire more than
59:07100 system installation with
59:1013,000
59:12case done. And the specialty urology,
59:16gynecology, general surgery including
59:18upper GI, lower GI and HPB. Even
59:21thoracic we had a
59:23system. We had a
59:25experience. And it's expanding a lot
59:27abroad and it's increasing a lot.
59:30So, fantastic system. Um
59:33A lot of people are asking when is it
59:34going to be available in Europe?
59:36>> Yeah, you know, this is a really not our
59:39hand and not by the way the hand, but uh
59:41I can say beginning of the next year you
59:44can uh touch you know the with the
59:46Leonardo da Vinci clinical. Yeah. And
59:48you And
59:49can people get in touch with somebody
59:51now if they want to talk about
59:52potentially getting a system in the
59:54future? Who Who would they reach out to?
59:57Uh if you're okay, you can directly
59:59contact me or uh our
1:00:01uh commercial director uh Javier Bronte.
1:00:04And uh in Italy uh earlier Marco
1:00:07Zambonini, you can contact our member
1:00:10and then you can reach out through
1:00:12LinkedIn and through our email and
1:00:14through our in in OC uh digital anytime.
1:00:19Perfect. Thank you.
1:00:20Great to be here with you today. Nice to
1:00:22see you again, Steven. So, look, you
1:00:25you've been involved in laparoscopy for
1:00:27probably as long as I have and you've
1:00:29seen the whole change from open to
1:00:30laparoscopic and the move to robotic and
1:00:33you've been involved with robotic
1:00:35systems. Tell me a little bit about
1:00:37what's attracted you to Medicaroid and
1:00:38Hinotori. Yeah, thank you, Steven. Uh I
1:00:41believe that the really with the
1:00:42robotics we are where we were probably
1:00:44with the uh laparoscopy 30 years ago. We
1:00:47do represent of course the future. I
1:00:49believe that uh you know, Hinotori
1:00:51because also of the Kawasaki technology
1:00:54is going to be a a step forward uh and
1:00:57the precision and the experience of a
1:01:00Kawasaki in robotic can really bring
1:01:02something different and the an
1:01:04alternative to what has been used in the
1:01:07in the last 25 years.
1:01:09Uh uh is not uh a a clone or something
1:01:13else, but is a a robot that is bringing
1:01:16some different things in to the table
1:01:19and
1:01:20some innovation in some area.
1:01:22And it's incredibly high quality as
1:01:24well, by the way. Absolutely. Yeah. So,
1:01:26um
1:01:27if people want to get hold of you, get
1:01:29hold of uh on the system, how how how
1:01:32can they do that?
1:01:34Uh as uh
1:01:35as we said, we have a different uh
1:01:37sites. We have a two different uh
1:01:40training center in Europe, IRCAD and
1:01:43ORSI. And of course uh through me or
1:01:47through Medicaroid uh
1:01:49uh in LinkedIn, you can you can easily
1:01:51find us. We can discuss about the
1:01:53possibility to have a try uh what we
1:01:55call a test drive.
1:01:57Uh today we are here at the Gemelli
1:02:00training center uh in occasion of the
1:02:02SICO Congress and we're going to give
1:02:05the possibility to everyone who's coming
1:02:07to our booth to to have a test drive for
1:02:10for some years to us. Well, I think
1:02:12they'll enjoy the test drive. I think
1:02:13they'll find it quite great and
1:02:15hopefully at this video they'll get to
1:02:16see uh some of the quality of this
1:02:18product.
1:02:19>> Absolutely. And thank you for coming. It
1:02:20was really a pleasure to you know, I
1:02:23mean these uh couple of hours with you.
1:02:25Thank you very much.
1:02:26>> Thank you.
1:02:29Great. So, I hope you found that
1:02:30fascinating. Um really good deep dive.
1:02:33Thank you to Tetsui, to Marco, and to
1:02:36Sebastian for uh taking me through that
1:02:38in such great details.
1:02:40So, what do I What do I think of it? So,
1:02:42um the first thing you'll notice with
1:02:44that system is amazing quality. And uh
1:02:49there's just no doubt about it. You
1:02:50know, it's really good Japanese quality
1:02:55and coming out of the Kawasaki um
1:02:57house, you can't expect anything else.
1:03:00And And really in
1:03:02um
1:03:03in Japanese products there's always just
1:03:05amazing quality. And the instruments
1:03:07felt really really good. And they're
1:03:10already at 20 uses and you can see that
1:03:12with the HF2 series that they're at 20
1:03:14uses. Very nice small compact. We'll get
1:03:17into instruments in a minute. I'll I'll
1:03:19take I'll take through everything that
1:03:20that I that I noticed on the system.
1:03:24So, let let's talk first of all So, the
1:03:26good thing is it's a Japanese quality.
1:03:27It's an amazing quality. For me, one of
1:03:30the difficulties I have with the whole
1:03:31system and um
1:03:34again, it's a little bit like if I said
1:03:35to you, "Describe to me driving a car."
1:03:37it would be really really um laborious
1:03:41for you to go through every step of
1:03:42driving the car. So, it can feel a
1:03:44little bit just a little bit uh
1:03:47long-winded in terms of that, but that
1:03:49Sebastian explained to me in in great
1:03:51details as if he was doing a full demo
1:03:53for a nursing team or for a surgical
1:03:55team.
1:03:56Uh so, I can assure you it's it is much
1:03:59faster than it feels when you're doing
1:04:00this in a video. Um
1:04:02But,
1:04:03it is still for me very um
1:04:06engineering driven. I I think there's
1:04:09been too much engineering put into this.
1:04:11There's too many presses, buttons,
1:04:13menus,
1:04:14uh tick boxes, steps that you have to
1:04:17do. There's too many buttons on the
1:04:20arms, you know, forwards, backwards,
1:04:21mode, jog, shuttle. Makes it very nice
1:04:25to use, by the way. You know, the the
1:04:26way that you can move the arms around
1:04:28with the small joystick, etc. in the
1:04:29different modes.
1:04:31But, it is very very complex from that
1:04:33point of view.
1:04:35So, let me talk about the individual
1:04:36pieces. So, that's the They're my two
1:04:37things. It's great quality,
1:04:39but it can feel a little bit
1:04:40overwhelming and a little bit complex
1:04:42and I would say to the um Hinotori
1:04:45engineers, make it simple in the future.
1:04:47Make it as simple as possible and as
1:04:49user-friendly as possible
1:04:51uh for for the users. Reduce some of the
1:04:53steps.
1:04:55So, let's talk for first of all about
1:04:57the bedside unit. The bedside unit the
1:04:59boom itself is actually quite compact
1:05:01and quite small compared to something
1:05:03like an XI. So, I was actually quite
1:05:05impressed with that and the arms are are
1:05:07gorgeous, you know, they're really thin,
1:05:098° of freedom. Really helps you to
1:05:12position them in a way that you you can
1:05:13avoid clash. The Z rails are amazingly
1:05:16small and compact and the drive units
1:05:19for the
1:05:20uh for the instruments are some of the
1:05:22best that I've seen in terms of quality,
1:05:24size, compactness,
1:05:26and just the engineering that's behind
1:05:28it is really really uh nice and clever.
1:05:32Talk about the elephant in the room. The
1:05:34base unit footprint-wise it's about the
1:05:36same as an XI. You know, I sat and
1:05:38measured it and went through it. It's
1:05:39about the same as an XI.
1:05:41But, it's really tall, big, and heavy
1:05:43and it just feels massive in the room
1:05:46and um you know, you you drive it with
1:05:49almost like a motorbike steering thing
1:05:51and it's got three wheels, so it drives
1:05:53really really well. It actually was easy
1:05:55to drive forwards and backwards and you
1:05:56can change the speed that you move
1:05:57around at. But, it just feels massive in
1:06:00the room. It feels like it takes up a
1:06:02huge piece of the operating room. And
1:06:04again, in the future I would wonder
1:06:05whether they could make that a little
1:06:06bit smaller.
1:06:09It is also for me, you know, the the
1:06:11whole way that the thing comes out and
1:06:13and packs away and goes into a V is
1:06:15really nice. You know, it's Japanese
1:06:17origami at its best.
1:06:19But, it just feels slow and laborious
1:06:21the way the whole thing unfolds and and
1:06:24comes out and and and then switches
1:06:26around to the patient um orientation.
1:06:29Clever, lots of modes in there for
1:06:31whether you're going down one way in the
1:06:33pelvis or up into the chest or or
1:06:35whichever way that you're using it. It's
1:06:36all very very clever, but it feels a
1:06:38little bit of an over-engineering to me.
1:06:40But, it is gorgeous the way it does it.
1:06:43It's super controlled. You know, you
1:06:44have that one joystick system to move it
1:06:46around where you want it.
1:06:49I did like the um visual system on the
1:06:52uh arm that looks down onto the onto the
1:06:54patient. That was nice for the docking
1:06:56and bringing the system in. It gave you
1:06:58some really nice accuracy. And then what
1:07:00I really did like was the fact that then
1:07:01from the boom, you can then orientate
1:07:03the boom in two or three different ways.
1:07:06There's sort of like a pitch and there's
1:07:07an angulation. So, that you can make
1:07:09sure that the arms are approaching the
1:07:11patient at the at the best angle that
1:07:13they can.
1:07:15And um
1:07:16yeah, that was interesting.
1:07:18I I found the entire
1:07:21the way that they um
1:07:24do the pivot point excessively
1:07:26engineering heavy. The fact that you put
1:07:29on a a pivot point pointer and you point
1:07:31to the skin and then it works out the
1:07:32depth is really nice, but it feels
1:07:34engineering heavy and I wonder whether
1:07:35some teams, you know, it's going to take
1:07:37them a little while to get used to doing
1:07:38that. Uh it is clever the way that it
1:07:41does it, but I've seen other systems
1:07:42like CMR and I've seen a Senseus with
1:07:45their Luna that does automatic pivot
1:07:47pointing and I wonder whether their
1:07:48engineers could just do a little bit
1:07:50more work on that. However, with their
1:07:53system it does give you a good visual
1:07:54display, gives you the trocar distances
1:07:56between them so that you always make
1:07:58sure that you're op- optimal distances.
1:08:00You're not going to be in so much clash.
1:08:02And again, the arms are very slim and
1:08:05small and you can get them very close
1:08:06together. So, that was really nice. So,
1:08:08I think I think that overall
1:08:11uh it's nice, but it's too engineering
1:08:13heavy
1:08:14for me and I think that that's going to
1:08:16cause some teams um
1:08:19in some hospitals to feel a bit That
1:08:21that feels like it's quite an awkward
1:08:22way to set it up. But, it is nice and
1:08:24it's clever the way that it does it.
1:08:27Uh in terms of the ports, ports are very
1:08:29nice. Um let's talk about the
1:08:31instruments that attach onto the arms.
1:08:32Great range of instruments and they've
1:08:34already got some clip appliers and
1:08:35stuff. There are advanced energies and
1:08:37all those things coming down the pipe.
1:08:39The instruments are beautiful build
1:08:40quality. You have to feel them. I mean,
1:08:42it's typ- it's typical Japanese
1:08:44instrumentation.
1:08:46Uh the quality of Kawasaki behind them.
1:08:48It just They just feel really really
1:08:50nice and um they don't feel bulky and
1:08:53they don't feel heavy at all.
1:08:55And yeah, uh full degrees of of movement
1:08:59in the wrists and the endo wrists. Very
1:09:02very good. And yeah, very impressed with
1:09:04their instrumentation. I thought it was
1:09:06uh it was really superb and and the
1:09:07connectors that come onto the
1:09:09instrumentation were very nice as well.
1:09:11Visualization system Rubina 4K and they
1:09:14do use the full 4K and I'll talk a
1:09:16little bit about that when I talk about
1:09:17the console.
1:09:19Yeah, very very nice. And the fact that
1:09:21you can put that into 3D on the screen
1:09:23as we saw uh is a really really good.
1:09:27That's something that gets asked uh
1:09:29by bedside teams and nursing teams all
1:09:31the time. They just put the glasses on
1:09:33and you see really good 3D up on the
1:09:34screen.
1:09:36So, whoever's doing bedside has the full
1:09:37advantage of the 3D scope all the way
1:09:40there. Uh it's Rubina, so it's really
1:09:42good quality, brilliant image, uh
1:09:44luminosity,
1:09:45uh ICG and all the modes for that really
1:09:48really good. I like the fact the camera
1:09:50can flip up and down really fast. It
1:09:52does, you know, orientation from 30° up
1:09:55and 30° down really well, really really
1:09:58fast, really nice all from the console.
1:10:01That was nice. Um moving over to the
1:10:04console, the console is lovely. The the
1:10:07the Sony 4K um
1:10:11viewer is pretty amazing.
1:10:14And I don't know if you picked up what
1:10:15they talked about in there. So, a lot of
1:10:17the viewers in there are like
1:10:18like almost like a square kind of 4x3.
1:10:21This is 16x9.
1:10:23So, this is a full wide 16x9
1:10:27in 4K and the monitor in the the
1:10:29eyepiece inside are in 4K.
1:10:32Lovely, really really good uh
1:10:34visualization. I I think it's probably
1:10:36the best that I've sat on so far in
1:10:39terms of the uh headpiece and
1:10:41visualization and it's small and you can
1:10:43get the adjustments exactly where you
1:10:45want it really really easy. You just
1:10:47bring it to your face and you can get
1:10:48your neck really really comfortable in
1:10:50it. Fine with glasses, fine without
1:10:52glasses. It was just Yeah, I really
1:10:53liked that.
1:10:55The controls are interesting that you
1:10:56can you can change the sort of the
1:10:58weight of the controllers so that how
1:11:00much resistance they give you, the
1:11:01gravity resistance that they give you.
1:11:03That was a nice touch. You can have them
1:11:05super light or you can add some more
1:11:07weight in there so that, you know, it it
1:11:09feels like it gives you more control.
1:11:11And that's independent of the scaling.
1:11:13The scaling was in there as well that
1:11:14you're able to do. So, with that
1:11:15combination of weight of the controllers
1:11:17and scaling, I felt you could get really
1:11:19brilliant control of the um
1:11:22of the hand controllers.
1:11:25Foot pedal's nice. Some clever uh
1:11:27software in there showing you where your
1:11:28foot is touching and not touching. Very
1:11:31uh if you if you can use an X I's foot
1:11:34pedals, you'll be able to use this. Very
1:11:37nice uh nice that you can adjust the
1:11:39distance that it goes in and out. So, I
1:11:41could get really comfortable on that
1:11:43console. Nice small LCD screen at the
1:11:45bottom so you can adjust everything from
1:11:47there. But really, just get in, get
1:11:49going. I think it was It's a It's a
1:11:51really nice console.
1:11:53One notice about that is that um
1:11:56it it's really clean at the back. I
1:11:59again, go back and look at the piece
1:12:00where I showed the back. The reason why
1:12:01I zoomed in on that is that it's really
1:12:03really clean. The way that they've done
1:12:05the cabling and all the connectors is
1:12:07super nice. It's really high quality.
1:12:09It's just clear that they've got a lot
1:12:10of industrial design over years and
1:12:12years. And the annotation um output was
1:12:15really interesting. You can have a 2D
1:12:17annotation screen so that you can
1:12:19actually write on the screen or draw or
1:12:20you can do telestration on the screen.
1:12:23Very very nice.
1:12:24So, all in all, um
1:12:27console as good as anybody's out there.
1:12:29Absolutely no doubt about it. And the
1:12:30quality was beautiful and the hand grips
1:12:32were really really nice and the whole um
1:12:35kinematics of the way that it worked, I
1:12:38I was told before going in a couple of
1:12:40weeks ago that the kinematics on this
1:12:41are weird because it's not a remote
1:12:43center.
1:12:45Didn't find that at all. It felt exactly
1:12:47as if I was using any other console. The
1:12:50kinematics were really good. Lag was
1:12:53almost zero. It was brilliant lag. Um
1:12:55didn't have too much A little bit of
1:12:57vibration that you get with non-remote
1:12:59center systems that if you do a launch
1:13:01and a stop of the instruments, you get
1:13:03this kind of movement. Um that seems to
1:13:06be common on all systems that don't lock
1:13:09onto the trocars as much.
1:13:12But no problem for from a stability
1:13:14point of view. It was It was really
1:13:16good. And I think anyone using this
1:13:17would find it smooth unless they took it
1:13:19to the extremes like I was doing to
1:13:21provoke the system.
1:13:22I think they'll find it a really um a
1:13:25really smooth and good system.
1:13:28What else would I say on there? Um
1:13:31yeah, console just really good. Tower,
1:13:33it's a it's, you know, it's
1:13:36got the Hinotori control box in it at
1:13:38the bottom and then you've got your
1:13:39Storz integration at the top and they're
1:13:41very well integrated into Storz. And
1:13:44it's a lovely system. They use the Storz
1:13:46electrosurgery um insufflation would be
1:13:48the Storz insufflation.
1:13:51Storz imaging, all very very good and
1:13:54all logically works together. And the
1:13:55beautiful big screen that's a 3D screen
1:13:57on the tower is very very nice and
1:14:01everything works well. The software
1:14:02works well between it. It's just a very
1:14:04well-thought-out system and I I really
1:14:07liked it.
1:14:09So, if if I talk from a technical point
1:14:11of view, I think the base is still too
1:14:12big on the bedside boom, but the boom
1:14:15itself is not as big as it I I sort of
1:14:18had in my head that it was much bigger.
1:14:19It's actually more compact than I
1:14:21thought and it's nice that you can get
1:14:22the angles. Very nice slim arms. I think
1:14:24anyone would appreciate the Kawasaki
1:14:26technology in those arms that are really
1:14:29beautiful. Instruments beautiful.
1:14:30Console as good as anybody's and I think
1:14:32the best viewfinder that I've so far had
1:14:35on the market. So,
1:14:36really good system.
1:14:38Um the question that I and I asked this
1:14:40to the team from Medicaroid, you know,
1:14:43so what is it that, you know, what why
1:14:45would I take this and not another
1:14:48system? So, I think
1:14:51in my mind, and this is again just my
1:14:53opinion, it's my own personal opinion.
1:14:55What comes from me is that if you're
1:14:57somebody who's looking for a boom robot,
1:15:00then this should be on your list to try.
1:15:02Absolutely should be on your list to
1:15:04try. Um
1:15:06I think that some of the benefits you
1:15:08get is you get 20 um uses on each
1:15:11instrument. So, that's really really
1:15:12good.
1:15:14I think what you also get though is you
1:15:15just get the guarantee of a big
1:15:18solid Japanese company behind this. You
1:15:21know, Kawasaki is not going anywhere.
1:15:23So, if you're getting into a 7-year
1:15:25relationship with this company, it's
1:15:26going to be around in 7 years.
1:15:29It is very good. It's got really good
1:15:31telesurgery as well, which has been
1:15:33proven out in, you know, thousands and
1:15:34thousands of cases in Japan.
1:15:37So, if you just I don't think you get
1:15:39anything more or more interesting than
1:15:41something like an X I or a MicroPort or
1:15:43anything. I think I think you get the
1:15:45same sort of functionality that's in
1:15:47there.
1:15:48What I think you get is you get an
1:15:49alternative. So, if you don't want
1:15:51another X I in your hospital or you
1:15:53don't want to take an X I, you don't
1:15:54want to buy into the intuitive um
1:15:57lifestyle and moat and architecture
1:16:00and you're saying, you know, we want a
1:16:02different system that's in here, then
1:16:04this should definitely be on your
1:16:06shopping list to look at. It's It's a
1:16:07really high-quality
1:16:10system. Can it do procedures?
1:16:12Absolutely. Um Does it do do them really
1:16:15well? Everything I've seen from the
1:16:16clinical um
1:16:18images and the talking with surgeons
1:16:19that have used it, yes, it does it
1:16:21really really well. Is it a genuine
1:16:24alternative to
1:16:27an X I? Yes. Do I think that it's going
1:16:29to be a cheap alternative? No. I think
1:16:32that you're not going to get such things
1:16:33as a cheap alternative to any robot
1:16:36anywhere. It and you shouldn't be
1:16:38thinking that way. You should be
1:16:39thinking, is it going to be roughly the
1:16:41same cost per case or maybe less per
1:16:43case slightly? But it's not about being
1:16:46cheap. It's about maybe being a bit more
1:16:47frugal than um some other systems.
1:16:50Maybe.
1:16:51But I think what you really get is you
1:16:53get a, you know, you can say I've got an
1:16:55a a different alternative. If you don't
1:16:57like BMWs and you want to buy a
1:16:58Mercedes, there you go, you know, you
1:17:00you've got it there. Um
1:17:03So, I think that that's what they they
1:17:05kind of offer in there. Their training
1:17:06is excellent, you know, Sebastian is one
1:17:08of the best. He He was really good at
1:17:09the last company I was at.
1:17:11Their level of support and training and
1:17:13their investment into places like Hercad
1:17:15is huge and I think that if you go there
1:17:18as a team, you will know how to come
1:17:19back and use that system. And I think
1:17:21that the system, you know, you you will
1:17:23get the most out of the system because
1:17:24of their support and their training and
1:17:26their servicing. They know how to do
1:17:28that as a company. That's the the bread
1:17:30and butter of Kawasaki for years and
1:17:32years. So, they know they really know
1:17:33how to do that.
1:17:35And I think that what you're basically
1:17:36getting here with Hinotori is a really
1:17:39good high-quality Japanese alternative
1:17:42to a da Vinci. And if you're in the
1:17:45market for something that's different
1:17:46and you want to have something that's
1:17:48different and if you're a I don't know,
1:17:50university hospital that's looking to be
1:17:51on the podium and be some of the first
1:17:54around Europe as soon as they get their
1:17:56CE mark and Tatsui mentioned the CE
1:17:58mark. Um as soon as they get the CE
1:18:00mark, you know, and and you want it to
1:18:01be alternative and you want to do the
1:18:02first 300, 400 cases with a different
1:18:05system, brilliant. There There's one to
1:18:08go for. So, all in all, yeah, was
1:18:11impressed. Um I think they need to make
1:18:13it a little bit easier in the future, be
1:18:15less technical, less engineering driven
1:18:17and more bedside team driven so that
1:18:20it's just easier and more more fluid to
1:18:22use. But a lot of the features are nice
1:18:24in there and I know they've got a lot of
1:18:26stuff coming for it uh in the in the
1:18:28near future. So, one to watch and
1:18:31definitely would
1:18:33would seriously think about going and
1:18:34getting a test drive on the Hinotori.
1:18:36Really worth um trying out and having it
1:18:39as a potential high-quality alternative
1:18:42to um
1:18:43to Intuitive if that's what you're
1:18:45looking for. So, I hope you found that
1:18:47review useful and I hope you now
1:18:49understand the system of Hinotori
1:18:50better. And again, thanks to the team at
1:18:52Medicaroid for doing that for me. Uh you
1:18:55know, it was a whole morning out of
1:18:56their time uh to do that with me. So, I
1:18:59appreciate it a lot and uh I'll catch
1:19:01you on the next one.

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