Robot‐Assisted Distal Pancreatectomy Using the Hugo RAS System via the Supragastric Approach: First Nationwide Case Report (With Video)

The Hugo RAS System received regulatory approval for gastroenterological surgery in Japan in May 2023. Beyond standard robotic advantages-three-dimensional high-definition imaging, articulated instruments with tremor filtration, and motion scaling-it features an open console that enhances team communication and four independent arm carts for flexible positioning. We report Japan's first case of robot-assisted distal pancreatectomy performed using the Hugo RAS System. The patient was a 78-year-old woman with a branch-duct intraductal papillary mucinous neoplasm in the left pancreas exhibiting high-risk stigmata. Four ports were placed laterally at the umbilical level, with an assistant port in the right subcostal region. Arm cart 1 was positioned on the patient's right caudal side, and the remaining three on the left cranial side. After division of the splenic artery via the supragastric approach, the pancreas and spleen were mobilized, and transection was performed at the pancreatic neck for specimen retrieval.