Robot-assisted pyeloplasty with the New Hugo™ RAS: step-by-step surgical settings and technique

We present our step-by-step experience regarding the feasibility and surgical setup for a case series of robotic pyeloplasty using the new Hugo^™ RAS System.

Five consecutives robotic pyeloplasties have been performed, through a trans-peritoneal route. Three robotic ports were placed under direct vision, including an optical 11-mm robotic trocar, and two 8-mm operative robotic ports. Two laparoscopic ports for bed-assistant were placed between robotic ports and below the camera port to avoid clashes. Only three arm carts were used and located behind the back of the patient to leave more working space to the bed-assistant space and avoid internal or external clashes between robotic arms. After docking and paracolic gutter incision, kidney lower pole identification, UPJ stenosis excision, and spatulation of the ureter with double J ureteral catheter placement were key steps of our procedure.

Median Docking and Console time were 4 minutes (IQR: 4-5) and 115 minutes (IQR:105-120), respectively. No intraoperative complications occurred. No additional ports placement was necessary. No robotic instrument clashed, nor clashes between the robotic arms and the bed-assistant were observed. Estimated blood loss was negligible. The patients were discharged on postoperative day 3 after bladder catheter and abdominal drain removal. No complications were recorded within the first 30 postoperative days. Finally, a median follow-up of 4 (IQR: 3-8) reported satisfactory outcomes.

In the setting of robotic pyeloplasty, this novel platform showed a user-friendly docking system, providing satisfactory perioperative outcomes with a simple three-arms configuration.