Robot-assisted Pyeloplasty with HUGOTM Robotic System: Initial Experience and Optimal Surgical Set-up at a Tertiary Referral Robotic Center

Background: In February 2021 Medtronic® (Minneapolis, MN) launched the HUGOTM Robotic Assisted Surgery (RAS) System in the global market. The aim of the current study is to describe the first cases series and the optimal setup of robot-assisted pyeloplasty procedure, performed with HUGOTM RAS system in a tertiary referral robotic center. Methods: Data from consecutive patients who underwent robot-assisted pyeloplasty at OLV Hospital (Aalst, Belgium) were recorded. Baseline characteristics, perioperative and surgical outcomes were collected. Results: Overall, ten robot-assisted pyeloplasties were performed (October 2022-September 2023). Based on our expertise, the following minor setting changes have been made, relative to the official setup guide: the endoscope port and, subsequently, the left and right-hand ports were positioned more laterally. Additionally, the reserve/4th port was placed more laterally and cranially, and adjusted the arm cart's tilt angle, reducing it from -30° to -15°. The median docking time was 8 (Interquartile range [IQR]: 7.2-9.8) minutes, and the median active console time was 89.5 (80.0-95.8) minutes. No conversion to open/laparoscopic surgery or perioperative complications were encountered. A single technical problem was recorded in one (10%) procedure. Specifically, one arm was blocked, and the procedure was accomplished with three arms without compromising the procedure success. Conclusions: This study represents the first worldwide series of robot-assisted pyeloplasty performed with the HUGOTM RAS system and shows promising results. The procedure might be safely performed with this robotic platform achieving optimal perioperative outcomes.