Feasibility and setting of single docking HUGO RAS robot-assisted nephroureterectomy: first European experience

Robot-assisted nephroureterectomy (RANU) has demonstrated equal oncological outcomes and better perioperative outcomes compared to open and laparoscopic procedures for treating upper tract urothelial carcinoma (UTUC). However, RANU is still limited by technical difficulties like patient positioning, port placement, transitioning between anatomical regions and cost-effectiveness issues. The new surgical robot HUGO RAS increasing competition may spread the robotic approach also for this procedure. We aimed to demonstrate the feasibility of single docking RANU using HUGO RAS platform along with the description of our setting. We reported the first RANU performed in Europe at IRCCS Sant'Orsola Hospital (Bologna, Italy) using the HUGO^™ Robot-Assisted Surgery (RAS) System. Our main goal was to demonstrate the technical feasibility of RANU with HUGO^™ RAS along with its safety in terms of perioperative outcomes and complications. We also aimed to describe our surgical setup. We collected patient's characteristics, intraoperative and perioperative complications, docking time, operative time, clashing of the instruments, or technical errors of the system. The procedure was performed in a 78-year-old male with a clinically organ-confined high risk UTUC. No need for conversion to open/laparoscopic surgery was required. No intraoperative complications, instrument clashes or failure of the system that compromised the completion of the surgery were recorded. Docking, total operative, and console times were 7, 185 and 130 minutes, respectively. RANU with the HUGO^™ RAS System is a feasible and safe procedure in terms of perioperative outcomes and complications. Our setup allowed a rapid docking procedure and a smoothly completion of the surgery.