Clinical Scorecard: Exploring Advances in Gynecological Surgery: Initial Insights from the HUGO™ Robotic Surgery System at Two Tertiary Referral Centers

At a Glance

Key Highlights

• The HUGO™ RAS system was adopted in 2021 and used for 32 gynecological procedures between March 2022 and April 2023.
• Procedures included hysterectomy (62.5%), adnexal surgery (21.9%), and pelvic floor surgery ± supracervical hysterectomy (15.6%).
• Median docking time was 8 minutes, console time varied by procedure type, and no major system failures or conversions were reported.

Guideline-Based Recommendations

Diagnosis

• Patient selection based on gynecological indication including benign and malignant conditions.
• Preoperative assessment including age, BMI, Charlson Comorbidity Index, and surgical history.

Management

• Use of HUGO™ RAS system with a 4-arm setup and specific port placements as per Medtronic guidelines.
• Dedicated surgeon training including e-learning and wet lab practice prior to clinical use.
• Patient positioning in Lloyd Davies 20° Trendelenburg with uterine manipulators tailored to procedure type.

Monitoring & Follow-up

• Recording docking, console, and skin-to-skin times for operative efficiency assessment.
• Monitoring perioperative complications using Clavien–Dindo classification.
• Tracking instrument clashing, technical errors, system failures, estimated blood loss, catheter removal day, and length of stay.

Risks

• Potential for technical errors or system failures, though none reported in this series.
• Consideration of patient comorbidities and prior abdominal surgeries in surgical planning.

Patient & Prescribing Data

32 women undergoing robotic gynecological surgery at two tertiary centers

Robotic surgery with HUGO™ RAS system is feasible and versatile for a range of benign and malignant gynecological procedures with acceptable operative times and perioperative outcomes.

Clinical Best Practices

• Ensure comprehensive surgeon training including e-learning and wet lab practice before clinical implementation.
• Adhere to standardized port placement and docking protocols to optimize operative efficiency.
• Use appropriate uterine manipulators based on surgical indication to facilitate procedure.
• Maintain pneumoperitoneum at 8 mmHg and use 30° or 0° endoscope depending on procedure type.
• Monitor operative metrics and complications systematically to guide quality improvement.

References

• Medtronic HUGO™ RAS System CE Mark Approval
• Studies on HUGO™ RAS system feasibility and versatility
• Case series and reports on gynecological use of HUGO™ RAS