Initial experience in colorectal robotic surgery in a university hospital: the first 100 consecutive cases using...

The Hugo™ RAS platform (Medtronic^®), featuring an open-console design and modular configuration, represents a novel alternative to established robotic systems. Limited large-scale series of colorectal procedures using this platform have been published. This study aimed to evaluate the feasibility, safety, and learning curve of implementing the Hugo™ RAS platform for colorectal surgery in a center without prior robotic experience.

We retrospectively analyzed 100 consecutive adult patients (median age 68 years; 51% male) undergoing elective colorectal resection using Hugo™ RAS between April 2023 and December 2024. Surgical indications included malignancy (78%), benign neoplasia, and inflammatory disease. Primary outcomes included operative time, blood loss, conversion rate, oncologic adequacy, complications (Clavien-Dindo classification), and length of stay. Learning curves were assessed via CUSUM analysis.

Median operative time was 180 min (IQR 147.5-240.0), with blood loss of 50 mL (IQR 50-100). No conversions occurred. R0 resection was achieved in 93% of applicable cases, with median lymph node harvest of 20. Overall morbidity was 28%, including 5% major complications (Clavien-Dindo ≥ IIIb) and zero grade IV/V events. Median stay was 6 days. Male patients had significantly higher complication rates (39.2% vs 16.3%, p = 0.011). Comparing first versus last 50 cases, complications decreased from 34% to 22% (p = 0.181), while major complications remained stable. CUSUM analysis revealed stabilization after approximately 50 cases.

The Hugo™ RAS platform enabled safe and effective colorectal surgery with zero conversions and oncologic outcomes meeting established benchmarks. The learning curve stabilized at 50 cases with progressive reduction in minor complications. These results support Hugo™ RAS as a valuable addition to minimally invasive colorectal surgery.