First Robotic Hysterectomy Using Hugo RAS System for a 2-Kg Uterus: Technical Insights From a High-Volume Center

We present the first documented case of a 2-kg uterus successfully managed with the Hugo RAS system. The patient was a 45-year-old nulliparous woman with multiple fibroids and bilateral ovarian cysts. After a six-month course of relugolix to improve anemia, we performed a total hysterectomy using Hugo. A "Narrow setting" port configuration was employed. The procedure was completed in 155 min, with a console time of 77 min and a docking time of 7 min; estimated blood loss was 50 mL. No intraoperative or postoperative complications occurred. Strategic port placement, early uterine artery ligation, and dividing the surgical procedure into defined anatomical zones helped minimize blood loss and maintain clear visualization. While this single-case experience is limited in generalizability, it provides valuable insights into surgical strategies for large benign uterine conditions.