Robot-assisted Partial Nephrectomy with the new HugoRAS System: single center matched-pair analysis

Robotic-assisted surgery represents a leading innovation in kidney-sparing procedures across specialized urology centers. As new robotic platforms continue to emerge, comparisons with conventional laparoscopy remain necessary. This study focuses on comparing oncological, perioperative and functional outcomes of robot-assisted partial nephrectomy (RAPN) with the Hugo™ RAS system and laparoscopic partial nephrectomy (LPN) within a tertiary institution.

A retrospective single-center study included 165 patients who underwent LPN (n=95) or RAPN (n=70). Perioperative clinical data, tumor characteristics, oncological and functional outcomes were obtained. Propensity score matching (1:1) was implemented to mitigate selection bias. Trifecta and pentafecta were assessed as composite surgical success endpoints. Multivariate logistic regression analyses were performed to identify the predictive factors for each.

Following propensity score matching, 70 patients were included in each group. Operative time, WIT and estimated blood loss did not differ significantly. RAPN was associated with a shorter length of stay (3 days vs 5 days, p<0.001) without increased complication rate. Renal functional outcomes, including ≥90% eGFR preservation and CKD upstaging, were similar. Trifecta (LPN 84.3% vs. RAPN 85.7%) and pentafecta (LPN 48.6% vs. RAPN 57.4%) achievement were comparable. On multivariate analysis, higher RENAL score was the only independent predictor of trifecta failure (OR 1.410, p=0.027). For pentafecta, higher RENAL score (OR 1.396, p=0.030), older age (OR 0.929, p=0.001), and lower pre-operative eGFR (OR 0.981, p=0.049) were independent predictors of failure.

The study reinforced the effectiveness and safety of the new Hugo™ RAS platform for partial nephrectomy, without compromising oncological and functional success.