Robotic posterior retroperitoneoscopic adrenalectomy: initial experience with Hugo™ RAS system

Robot-assisted surgery has revolutionized minimally invasive procedures, offering superior three-dimensional visualization and mobile instruments suitable for smaller areas. For this reason, robotic retroperitoneal adrenalectomy (RRA) is emerging as an ideal procedure for this technology. This study aimed to assess the outcomes of the first 10 consecutive cases of this procedure using the RAS Hugo™ platform. Conducted between July 2023 and February 2024, the surgeries were performed with patients in the prone position, accessing the retroperitoneal space using standard endoscopic techniques. High-energy sealing instruments were utilized for adrenal vein sectioning, and specimens were extracted using protective bags. Ten surgical interventions were performed, with six male patients and four female patients. Most patients underwent surgery due to suspected primary hyperaldosteronism (n=7), while the remainder were operated on for Cushing's syndrome (n=3). Median patient age was 58 years (range 50-73) with a median BMI of 28.5 kg/m² (range 21-36), and American Society of Anaesthesiologists (ASA) risk scores were evenly split between ASA II and ASA III. Lesions were equally distributed between the right and left adrenal glands, with a median tumor size of 1.5 cm (range 0.5-3.5). Median operative time was 124.5 min (range 102-198), with one case requiring conversion to endoscopic approach due to pyelonephritis. No postoperative complications were reported, and median hospital stay was 1 day (range 1-3). RRA demonstrates feasibility for selected patients, offering enhanced image resolution and precision in confined spaces. However, challenges such as increased operative time and the need for skilled teams warrant consideration.