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Initial Experience With Robot-Assisted Nephroureterectomy Using the Hugo Robot-Assisted Surgery System via a

Shuichi Morizane1, Atsushi Yamamoto1, Hiroshi Yamane1

  • 1Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan.

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Retroperitoneal robot-assisted radical nephroureterectomy (RANU) using the Hugo robot-assisted surgery system (HRS) is feasible and may reduce arm interference. Further research is needed to confirm these findings in larger patient cohorts.

Keywords:
Hugo robot‐assisted surgery systemarm interferenceretroperitoneal approachrobot‐assisted nephroureterectomy

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Area of Science:

  • Urology
  • Robotic Surgery
  • Surgical Oncology

Background:

  • Robot-assisted radical nephroureterectomy (RANU) is a key procedure for upper tract urothelial carcinoma.
  • Evaluating new robotic systems like the Hugo robot-assisted surgery system (HRS) is crucial for optimizing surgical techniques.
  • Comparing transperitoneal and retroperitoneal approaches is essential for determining optimal port placement and improving patient outcomes.

Purpose of the Study:

  • To determine optimal port placement for retroperitoneal RANU using the HRS.
  • To compare perioperative outcomes between transperitoneal and retroperitoneal RANU with HRS.
  • To assess and compare arm interference and system-related errors between the two approaches.

Main Methods:

  • Retrospective analysis of 21 patients undergoing RANU with HRS (2023-2025).
  • Patients were divided into transperitoneal (n=13) and retroperitoneal (n=8) groups.
  • Comparison of demographics, perioperative metrics, arm interference, and system errors using appropriate statistical tests.

Main Results:

  • Operative times, blood loss, and complication rates were similar between approaches.
  • Retroperitoneal RANU showed significantly fewer arm-interference errors (p=0.011).
  • Transperitoneal approach had a shorter incision-to-roll-in time (p=0.015), while retroperitoneal favored roll-in to console start (p=0.045).

Conclusions:

  • Retroperitoneal HRS-RANU is a feasible approach in the studied cohort.
  • The retroperitoneal approach may offer advantages in reducing arm interference during RANU.
  • Larger studies are warranted to validate these preliminary findings and confirm the benefits of retroperitoneal HRS-RANU.