Development and Validation of the HUGO-SWAP Workflow for Single-Docking Robotic Colorectal Surgery

BackgroundIndependent-arm robotic systems offer flexible instrument assignment, but standardized colorectal workflows are limited. We developed the HUGO-SWAP workflow, a single-docking strategy enabling phase-specific instrument reassignment, and evaluated its clinical feasibility.MethodsFrom April 2020 to December 2025, 298 patients underwent robotic colorectal resection. After exclusions, 274 patients were analyzed. Propensity score matching (1:2) was performed to provide a comparative reference using the da Vinci Xi system. Postoperative complications were the primary outcome.ResultsAfter matching, 41 HUGO and 82 da Vinci cases were analyzed. Postoperative complication rates were comparable (19.5% vs 22.0%). Oncologic outcomes, including lymph node yield, pathological stage, and margin status, were similar. Operative time was longer in the HUGO group (254 vs 216 min), while no cases required re-docking or conversion.ConclusionsThe HUGO-SWAP workflow enables safe implementation of single-docking robotic colorectal surgery on an independent-arm platform, with preserved short-term safety and oncologic adequacy. These findings support the feasibility and reproducibility of this workflow in clinical practice.