Recent studies demonstrated that, in the last decade, with the innovation of robotic surgery and with the introduction of dedicated robotic training programs, the related costs for robotic surgery might be reduced due to the significantly decreased length of stay, rate of complications, and readmissions.1-3 Furthermore, in the coming years, the global market for surgical robots is expected to grow, with new companies to entering the market, leading to potential cost savings thanks to less expensive devices and to increased competition between industries.2-4 In this context, in February 2022, the Medtronic modular multi-port robotic system, HUGO Robot-Assisted Surgery (RAS) System, received the CE Mark approval for urological, gynecological, and general surgical procedures in adults. The new HUGO RAS consists of a system tower, an open console with innovative hand controllers with a “pistol-like” design, and four independent arm carts.
There is limited clinical data on non-oncological procedures performed with the new HUGO RAS system in Urology. In our video article, we described two surgical techniques for RASP and reported the first series of RASP performed with this new robotic platform.5
Median docking, operative, and console time were 7 (IQR: 5 – 9), 165 (IQR: 121 - 180) and 125 (IQR: 101-148) minutes, respectively. No intraoperative complication occurred, and there was no need for conversion and/or additional ports placement. Median length of stay was 3 days and 80% of the patients removed the urethral catheter on the first postoperative day.
One of the main differences between the HUGO RAS system and other robot surgical platforms is the presence of four separate arm carts that must be docked individually. For this reason, longer docking times may be a concern, but literature reports indicate that the docking time for the HUGO RAS system, after the initial cases, is approximately 9 minutes, which is similar to the time reported by Broeders et al. for the da Vinci system.6,7
In my opinion, differently from Xi DaVinci robotic endoscope which uses “chip-on-a-tip” technology, giving 3-D vision with increased high-definition imaging and better coloring., the quality of the camera and vision in HUGO-RAS system does not result so precise and effective in defining the anatomic details. This can be explained as HUGO-RAS uses a standard 3D laparoscopic endoscope produced by an external company, which has still not reached the same level of definition guaranteed by Xi DaVinci system.
Moreover, previous experience with conventional laparoscopy can be considered more relevant and helpful during the learning curve with the HUGO-RAS system rather than the Da Vinci system.
Another actual limit of HUGO-RAS is still represented by the lack of standardization of trocar placement (especially for renal surgery) and by the reduced strength and life of some instruments such as bipolar forceps. Nevertheless, this is reasonable, and it can be considered a youthful blunder.
Finally, the bedside assistant can experiment with some problems that are represented by frequent collisions with the long robotic arms, which reduces his action space at the operating table.
On the other side, HUGO-RAS represents a less expensive robotic system in comparison to the DaVinci system and this could probably improve and help the spread of robotic surgery in more and more urologic centers, also for benign diseases.
Our series still represents the first report of surgical outcomes of RASP executed with the HUGO RAS System, which still represents a novel robotic platform but with an interesting and effective perspective in Urology, once all the youthful problems are solved by increasing clinical experience.
Written by: Francesco Greco, PhD, Urology Unit, Centro Salute Uomo, Bergamo, Italy
References:
- A. FUSCHI et al., “Holmium laser enucleation of prostate versus minimally invasive simple prostatectomy for large volume (≥120 mL) prostate glands: a prospective multicenter randomized study,” Minerva Urology and Nephrology, vol. 73, no. 5, Nov. 2021, doi: 10.23736/S2724-6051.20.04043-6.
- R. Farinha et al., “Potential Contenders for the Leadership in Robotic Surgery,” J Endourol, vol. 36, no. 3, pp. 317–326, Mar. 2022, doi: 10.1089/end.2021.0321.
- G. Ploussard et al., “Annual nationwide analysis of costs and post-operative outcomes after radical prostatectomy according to the surgical approach (open, laparoscopic, and robotic),” World J Urol, vol. 40, no. 2, pp. 419–425, Feb. 2022, doi: 10.1007/s00345-021-03878-0.
- Greco F, Pesenti N, Vismara A, et al. The impact of robotic surgery in bladder cancer patients. AME Med J 2021;6:14
- Piro A, et al. Initial experience of robot-assisted simple prostatectomy with Hugo™ RAS system: step-by-step description of two different techniques. J Endourol. 2023 Jul 26. doi: 10.1089/end.2023.0277.
- V. Elorrieta, J. Villena, Á. Kompatzki, A. Velasco, and J. A. Salvadó, “ROBOT Assisted Laparoscopic Surgeries For Nononcological Urologic Disease: Initial Experience With Hugo Ras System,” Urology, vol. 174, pp. 118–125, Apr. 2023, doi: 10.1016/j.urology.2023.01.042.
- E. M. van der Schans, M. A. J. Hiep, E. C. J. Consten, and I. A. M. J. Broeders, “From Da Vinci Si to Da Vinci Xi: realistic times in draping and docking the robot,” J Robot Surg, vol. 14, no. 6, pp. 835–839, Dec. 2020, doi: 10.1007/s11701-020-01057-8.