Safety and Feasibility of Cholecystectomy with the HugoTM RAS: Proof of Setup Guides and First-In-Human German Experience

Abstract

<b><i>Introduction:</i></b> The Hugo RAS robotic platform by Medtronic was recently certified for human use in Europe. Several centers have gained initial experience with this system in urology and gynecology. However, few data about its feasibility and safety in general surgery have been published. <b><i>Methods:</i></b> The first-in-human surgical procedures with the Hugo RAS in Germany were performed at our hospital in February 2023. We report our early experience with robotic cholecystectomy using this new platform. The primary aim was to test the setup guides of the manufacturer and to evaluate the safety and feasibility of Hugo RAS for this procedure. <b><i>Results:</i></b> A modified setup with two 11-mm ports and two 8-mm ports without an assistant port was used in 14 consecutive cases. A 30° or a 0° camera, a bipolar grasper or a Maryland on the left arm, a monopolar scissors on the right arm, and a double-fenestrated grasper on the additional arm were mounted. Clip application and gallbladder extraction were performed by the bedside assistant through the right arm 11-mm port. There were no complications, no adverse events, and no conversions. Arm collisions were reduced through slight corrections in trocar positions. <b><i>Conclusion:</i></b> Robotic-assisted cholecystectomy with the Hugo RAS was safe and feasible. The modularity of robotic arms allows individual setup modifications which may be of advantage for patients and surgeons.

Use of HugoTM RAS in General Surgery: The First 70 Cases at a German Centre and a Systematic Review of the Literature

“…Most publications on Hugo-cholecystectomy came from centres in Italy and Spain, reporting relatively small case series of up to seven patients. The largest reported singlecentre study provided technical details and setup modifications for the procedure in 14 consecutive cases-it was published by our team in 2023 [4]. Meanwhile, we have performed 32 CCEs with excellent clinical results and no technical problems.…”

“…The expectations of its successful use in general surgery are based on its open modular design allowing improved communication within the surgical team and the flexibility in the configuration of the four individual arms. The ergonomic position of the console for the surgeon, the pistol-like grips resembling laparoscopic ones and the lower price have been discussed as further possible advantages of Hugo [4][5][6][7]. The novelty of the device is inherently associated with some temporary disadvantages, such as the limited choice of instruments, lack of worldwide certification and approval for some major surgical procedures, immature training process, shortage of experienced proctors and difficulties in product supply.…”

“…Our surgical team had previous extensive experience with open and laparoscopic surgeries but no clinical experience with robotic surgery. Extensive theoretical and practical training offered by the vendor was completed as already mentioned in a previous report by us [4]. The system components of the Hugo RAS platform have been repeatedly described in detail elsewhere [5][6][7].…”

“…Currently, a total of 18 original papers by 11 different teams have been published, most of them coming from Italy (n = 7) and Spain (n = 4). A summary of these is presented in Table 2 [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. GERD-gastroesophageal reflux disease; rTAPP-robotic transabdominal patch plasty; rTAR-robotic transversus abdominis release.…”