Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center

Angelo Totaro; Eros Scarciglia; Filippo Marino; Marco Campetella; Carlo Gandi; Mauro Ragonese; Riccardo Bientinesi; Giuseppe Palermo; Francesco Pio Bizzarri; Antonio Cretì; Simona Presutti; Andrea Russo; Paola Aceto; Pierfrancesco Bassi; Francesco Pierconti; Marco Racioppi; Emilio Sacco

doi:10.3390/cancers16081602

Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center

Cancers (Basel). 2024 Apr 22;16(8):1602. doi: 10.3390/cancers16081602.

Authors

Angelo Totaro¹, Eros Scarciglia¹, Filippo Marino¹, Marco Campetella², Carlo Gandi¹, Mauro Ragonese¹, Riccardo Bientinesi¹, Giuseppe Palermo¹, Francesco Pio Bizzarri¹, Antonio Cretì¹, Simona Presutti¹, Andrea Russo³, Paola Aceto³, Pierfrancesco Bassi¹, Francesco Pierconti⁴, Marco Racioppi¹, Emilio Sacco²

Affiliations

¹ Department of Urology, Agostino Gemelli Hospital Foundation-IRCCS, Catholic University Medical School, 00167 Rome, Italy.
² Department of Urology, Isola Tiberina-Gemelli Isola Hospital, Catholic University Medical School, 00167 Rome, Italy.
³ Department of Anesthesia, Emergency and Intensive Care Medicine, Agostino Gemelli Hospital Foundation-IRCCS, Catholic University Medical School, 00167 Rome, Italy.
⁴ Department of Pathological Anatomy, Agostino Gemelli Hospital Foundation-IRCCS, Catholic University Medical School, 00167 Rome, Italy.

Abstract

Background: Robotic-assisted surgery is the gold standard for performing radical prostatectomy (RARP), with new robotic devices such as Hugo^TM RAS gaining prominence worldwide.

Objective: We report the surgical, perioperative, and early postoperative outcomes of RARP using Hugo^TM RAS.

Design, setting, and participants: Between April 2022 and October 2023, we performed 132 procedures using the Montsouris technique with a four-robotic-arm configuration in patients with biopsy-proven prostate cancer (PCa).

Outcome measures: We collected intraoperative and perioperative data during hospitalization, along with follow-up data at predefined postoperative intervals of 3 and 6 months.

Results and limitations: Lymphadenectomy was performed in 25 procedures, with a bilateral nerve-sparing technique in 33 and a monolateral nerve-sparing technique in 33 cases. The mean total surgery time was 242 (±57) min, the mean console time was 124 (±48) min, and the mean docking time was 10 (±2) min. We identified 17 system errors related to robotic arm failures, 9 robotic instrument breakdowns, and 8 significant conflicts between robotic arms. One post-operative complication was classified as Clavien-Dindo 3b. None of the adverse events, whether singular or combined, increased the operative time. Positive margins (pR1) were found in 54 (40.9%) histological specimens, 37 (28.0%) of which were clinically significant. At 3 and 6 months post-surgery, the PSA levels were undetectable in 94.6% and 92.1% of patients, respectively. Social urinary continence was regained in 86% after 6 months. Limitations of our study include its observational monocentric case-series design and the short follow-up data for functional and oncological outcomes.

Conclusions: Our initial experience highlights the reliability of the Hugo^TM RAS system in performing RARP. Additionally, we also list problems and solutions found in our daily work.

Keywords: Medtronic HugoTM RAS system; intraoperative technical data; prostate cancer; robot-assisted radical prostatectomy; robotic surgery; surgical outcomes.

Grants and funding

This research received no external funding.