Robot-assisted sacrocolpopexy using the Hugo-RAS system: initial series with no experience in robotic surgery

Pelvic organ prolapse (POP) is a common condition in women that negatively impacts the quality of life, including symptoms and effects on body image and sexuality. Robotic-assisted sacrocolpopexy (RASC) is established as a gold-standard treatment for POP, and most published evidence concerns the da Vinci robotic platform. New robotic systems are expanding the technological landscape; the Hugo-RAS platform is one of the most popular of them. Published experience with Hugo-RAS has focus mainly on prostate cancer and typically comes from centers with previous da Vinci experience. RASC articles with Hugo-RAS are very few. Moreover, the implementation of Hugo-RAS in an inexperienced robotics scenario remains unclear. We present our initial series of Hugo-RAS RASC performed by surgeons without prior robotic surgery experience to evaluate the safety, feasibility, and clinical outcomes.

Between November 2023 and March 2024, eight consecutive patients with symptomatic POP underwent RASC using Hugo-RAS system. The women included have a POP of ≥3 stage based on the POP-quantification (POP-Q). Perioperative parameters, complications, and functional outcomes were prospectively collected. Procedures were performed by a standardized technique including dissection, mesh placement, fixation to the cervix or vaginal vault and promontory, and peritonealization. A gynecological examination was carried out at discharge and at 45 days using the POP-Q system and the Patient Global Impression of Improvement (PGI-I) scale. The median operative time was 230 [interquartile range (IQR), 190-272] minutes, and the median estimated blood loss was 275 (IQR, 147.5-387.5) cc. The intraoperative complications occurred in one patient (opening of the vagina). The postoperative complications occurred in 2 patients and were Clavien-Dindo grade I-II. Median hospital stay was 3 days. At a median follow-up of 15.5 months, all patients showed objective anatomical improvement without recurrences and reported satisfaction with the surgery.

In our preliminary series RASC using Hugo-RAS for the treatment of POP is safe, feasible, and provides satisfactory short-term outcomes even by robotic-naive surgeons. More robust and comparative studies are needed to support these results and determine their definitive role in urogynecologic surgery.