The first 60 cases of robotic sacrocolpopexy with the novel HUGO RAS system: feasibility, setting and perioperative outcomes

New horizons in gynecological surgery: first-year experience with HUGO™ robotic-assisted surgery system at two tertiary referral robotic centers

The HUGO™ robotic-assisted surgery system (RAS, Medtronic, CA) consists of a 3D open console, four independent carts, and an integrated laparoscopic and robotic tower. Approved in 2021, it represents a novel alternative platform for robotic procedures. The aim of our study is to report the first-year experience with this system for gynecological procedures at two tertiary referral robotic centers. We prospectively collected and retrospectively analyzed data from patients underwent gynecological robot-assisted surgery with the HUGO™ RAS, at San Paolo University Hospital (Milan, Italy), and Onze Lieve Vrouw (OLV) Hospital (Aalst, Belgium), March 2022-April 2023. Demographic characteristics, intraoperative settings, and perioperative outcomes were investigated. A total of 32 procedures were performed: 20 (62.5%) hysterectomies, 7 (21.9%) adnexal surgeries, and 5 (15.6%) pelvic floor reconstructive surgeries. In 2022 and 2023, 13 (40.6%) and 19 (59.4%) procedures were carried out, respectively. The median docking time was 8 min (IQR 5.8-11.5). The median console and skin-to-skin time was 52.5 min (IQR 33.8-94.2) and 108.5 min (IQR 81.5-157.2), respectively. No intraoperative complications occurred. Two conversions to laparoscopy managed without any additional complications were needed. To the best of our knowledge, this is the first global series of gynecological procedures performed with the HUGO™ RAS. Our preliminary findings showed the system's feasibility reporting promising results. The observed upward trend in the total number of procedures during the analyzed period is encouraging. Further studies are needed to assess a standardized method in the gynecological field with the novel platform.

Da Vinci vs. Hugo RAS for robot-assisted radical prostatectomy: a prospective comparative single-center study

PURPOSE

To evaluate Hugo RAS against the Da Vinci system for Robot-Assisted Radical Prostatectomy (RARP) in prostate cancer treatment.

METHODS

We compared outcomes of 150 patients with prostate cancer undergoing RARP with either Hugo or Da Vinci systems. Our analysis included operative, postoperative, pathological, and functional outcomes.

RESULTS

Both groups had 75 patients. Baseline characteristics and tumor features were similar. Intraoperatively, Da Vinci had a shorter docking time (10.45 vs. 18.62 min, p = 0.02), but total operative times were comparable (145.34 vs 138.95, p = 0.85). Hugo outperformed in neck dissection and lymphadenectomy times (22 vs 13.67 min, p = 0.027 and 37.82 vs 45.77 min, p = 0.025). Postoperative metrics like stay duration, catheter time, and complications showed no significant difference. Functional results, using IPSS and IIEF5, were similar between systems. Six Da Vinci patients (8%) and nine Hugo patients (12%) experienced social incontinence (p = 0.072). Pathological outcomes like T stage, Gleason Score, and nodes removed were alike. However, Hugo had more positive surgical margins (20% vs. 10.67%, p = 0.034).

CONCLUSIONS

RARP outcomes using Hugo RAS were similar to the Da Vinci system in our study. More research and extended follow-up are required to ascertain long-term oncological and functional results.

Comparative analysis of robot-assisted simple prostatectomy: the HUGO™ RAS system versus the DaVinci® Xi system

BACKGROUND

Robot-Assisted Simple Prostatectomy (RASP) has emerged as a promising alternative in the treatment of benign prostatic obstruction (BPO). However, there is currently a lack of comparative studies evaluating different robotic platforms for performing RASP. Therefore, we aimed to compare perioperative and functional outcomes of RASP performed using the HUGO™ RAS System versus the DaVinci® Xi System.

METHODS

Forty consecutive cases of RASP performed between May 2021 and March 2023 with the HUGO™ RAS and the DaVinci® Xi at OLV Hospital (Aalst, Belgium) were included in this retrospective study. All surgeries were performed by three experienced surgeons using the same approach. Baseline characteristics, peri-operative and functional outcomes were collected and compared between the two groups.

RESULTS

The population was equally divided between the two groups with 20 patients in each group. There were no significant differences in preoperative patient characteristics between the two groups, except for the presence of bladder stones prior to the surgery (p = 0.03). No significant differences in total operative time and console time between the two groups were reported (p = 0.3). No cases required conversion to open surgery or additional port placement. During one case performed with the HUGO™ RAS, a malfunctioning monopolar curved shear had to be replaced. However, there was no statistically significant differences in terms of technical robotic problems between the groups (p = 0.3). There was no significant difference between the two groups in perioperative and functional outcomes (all p ≥ 0.2).

CONCLUSIONS

We did not observe any statistically significant difference in perioperative and functional outcomes in case of RASP performed with the HUGO™ RAS System and with the DaVinci® Xi System. These findings provide compelling support for considering the HUGO™ RAS as a promising tool for robot-assisted procedures, thereby expanding the utilization of robotics for benign conditions.

Evaluation status of current and emerging minimally invasive robotic surgical platforms

BACKGROUND

The rapid adoption of robotics within minimally invasive surgical specialties has also seen an explosion of new technology including multi- and single port, natural orifice transluminal endoscopic surgery (NOTES), endoluminal and "on-demand" platforms. This review aims to evaluate the validation status of current and emerging MIS robotic platforms, using the IDEAL Framework.

METHODS

A scoping review exploring robotic minimally invasive surgical devices, technology and systems in use or being developed was performed, including general surgery, gynaecology, urology and cardiothoracics. Systems operating purely outside the abdomen or thorax and endoluminal or natural orifice platforms were excluded. PubMed, Google Scholar, journal reports and information from the public domain were collected. Each company was approached via email for a virtual interview to discover more about the systems and to quality check data. The IDEAL Framework is an internationally accepted tool to evaluate novel surgical technology, consisting of four stages: idea, development/exploration, assessment, and surveillance. An IDEAL stage, synonymous with validation status in this review, was assigned by reviewing the published literature.

RESULTS

21 companies with 23 different robotic platforms were identified for data collection, 13 with national and/or international regulatory approval. Of the 17 multiport systems, 1 is fully evaluated at stage 4, 2 are stage 3, 6 stage 2b, 2 at stage 2a, 2 stage 1, and 4 at the pre-IDEAL stage 0. Of the 6 single-port systems none have been fully evaluated with 1 at stage 3, 3 at stage 1 and 2 at stage 0.

CONCLUSIONS

The majority of existing robotic platforms are currently at the preclinical to developmental and exploratory stage of evaluation. Using the IDEAL framework will ensure that emerging robotic platforms are fully evaluated with long-term data, to inform the surgical workforce and ensure patient safety.