Upper Urinary Tract Surgery with Hugo^TM RAS: A Systematic Review

Pelvic procedures with the Hugo™ RAS system maintain a stable setup with minimal variations, and upper urinary tract procedures exhibit significant variability in configurations and approaches. This review investigates the feasibility and safety of the Hugo™ RAS system in upper urinary tract procedure, analyzing the heterogeneous configuration possibilities offered by this multicart robotic platform.

A systematic review was designed following the PICO framework and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in Scopus, PubMed, and Embase, covering studies up to March 12, 2025. The protocol was registered on Open Science Framework prior to data extraction: https://doi.org/10.17605/OSF.IO/T9B4Q.

A total of 256 articles were identified. Nineteen studies were analyzed, including 226 patients. The majority were prospective studies (n = 10, 53%). Fourteen among the 19 studies evaluated robot-assisted partial nephrectomy, one robot-assisted radical nephrectomy (RARN), one nephroureterectomy, one adrenalectomy, and one pyeloplasty. One additional multiprocedure study reported two ureteral reimplantations, one ureteropelvic junction repair, one RARN, and one ureterolithotomy. Significant variations in robotic setup were observed: three robotic arms were used in 36.8% of the studies, while four arms in 52.6% of them. Mean operative time was 93 ± 41 minutes, docking time 7 ± 5.5 minutes, estimated blood loss 150 ± 86.15 mL, with a mean hospital stay of 3 ± 2 days.

Hugo™ RAS appears to be an effective robotic platform for upper urinary tract procedure, with high adaptability to the surgical field.