Robot-assisted partial nephrectomy using the novel Hugo™ RAS system: Feasibility, setting and perioperative outcomes of the first off-clamp series

Abstract

Introduction: Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System. Methods: Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic’s port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration. Results: Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4–8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68–115 min). Median estimated blood loss were 200 ml (IQR, 50–400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days. Conclusions: We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration.

Evaluation of Clinical Research on Novel Multiport Robotic Platforms for Urological Surgery According to the IDEAL Framework: A Systematic Review of the Literature

“…The remaining 59 studies included in our systematic review were noncomparative surgical series or case reports [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] .…”

“…Twenty-six studies reporting clinical data for the Hugo RAS system were included in our review [20] , [21] , [22] , [23] , [24] , [25] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] . Table 2 summarises data from studies on urological surgical procedures performed using the Hugo RAS system according to the IDEAL framework.…”

Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center

“…In other urological robotic interventions as well, initial reports on the utilization of Hugo TM RAS system seem to validate the feasibility and safety of the procedures conducted [27][28][29][30].…”

Trifecta Outcomes of Robot-Assisted Partial Nephrectomy Using the New Hugo™ RAS System Versus Laparoscopic Partial Nephrectomy

“…While the laparoscopic approach is still preferred mainly due to lower costs compared to robotic surgery, the advent of new platforms is changing the landscape of the medical market. The Hugo™ RAS System by Medtronic was recently introduced as a novel robotic tool characterized by four independent arm-cart dockings and augmented modularity, showing promising initial results [13,19,22]. The system consists of a console with two arm controllers operated with a grip similar to a pistol; a footswitch controlling the camera, energy source, and reserve arm; and four separate arm carts with six joints each for an increased range of motion.…”

“…Trocar configuration in RAPN using the Hugo™ RAS System was recently described in a three-arms setting [14,22], which involved an initial 11 mm robotic camera trocar along the pararectal line, positioned approximately 14 ± 2 cm away from the umbilicus. Two additional 8 mm operative robotic ports were placed under direct vision caudal to the endoscope trocar, which ensured appropriate distances from the optical port.…”