Robotic Myomectomy Using Hugo RAS Platform: a Step-by-Step on how to be Safe and Efficient

To describe a safe and efficient approach for robotic myomectomy using the Hugo RAS system, emphasizing aesthetic trocar positioning, optimized hemostatic strategies, and precise uterine reconstruction in a fertility-preserving setting.

Surgical video demonstration (case report).

Referral center (Einstein Hospital Israelita, São Paulo, Brazil), with active use of the Hugo RAS platform in gynecologic surgery.

A 41-year-old nulliparous woman with abnormal uterine bleeding and infertility desiring future fertility. Magnetic resonance imaging revealed an enlarged uterus (202 cm³) with multiple fibroids. The dominant lesion was a 5.5 cm FIGO type 2 anterior fibroid. Smaller fibroids did not distort the uterine cavity and were not removed to avoid unnecessary myometrial injury.

Robotic myomectomy was performed using three robotic arms and standard laparoscopic trocars, as the system does not require proprietary ports [1]. The approach was selected based on favorable fibroid size and location. Although robotic assistance is not indispensable, it may facilitate precise multilayer suturing and effective hemostatic control in fertility-preserving surgery. Low abdominal port placement was adopted for improved cosmetic results, acknowledging that this configuration may not be suitable for larger uteri. Hemostasis included temporary bilateral uterine artery clipping and intramyometrial vasopressin injection. Monopolar and bipolar energy were used. Specimen extraction was performed transvaginally using a protective bag; alternatively, contained cold-scalpel morcellation techniques may be considered in selected nulliparous patients. Operative time was 122 min, with 50 mL estimated blood loss and no complications [2].

Robotic myomectomy with the Hugo™ RAS platform showed feasible and safe performance in this selected case. There are currently no comparative studies supporting superiority over other robotic systems. VIDEO ABSTRACT.