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

Background: 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. Case Description: 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. Conclusions: 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.