Major colorectal surgery with Hugo™ RAS: initial experience of a German center and a review of the literature

Abstract

The recently introduced Hugo RAS robotic platform has mostly been used for well standardized urologic and gynaecologic procedures. Experience with this new system in general surgery and especially in major colorectal surgery is very limited. This is a retrospective series of the first 25 consecutive non-selected colorectal surgeries performed at a single German center. The lessons learned from our initial experience are presented along with a systematic review of the currently available literature on this topic. Ten sigmoid and seven rectal resections, four right and one left hemicolectomies, two Hartmann's reversals and an abdominoperineal resection were performed in 14 women and 11 men at the median age of 66 years for 12 benign findings and 13 malignancies. All procedures were performed using four robotic ports and a single 12 mm assistant port. Median docking, console and total operative times were 12, 170 and 270 min. Median blood loss was < 100 ml, and median stay was 8 days. The literature review identified five case series with a total of 23 colorectal procedures: 9 right and 1 left hemicolectomies, 5 ileocaecal, and 4 rectal and 4 sigmoid resections. Results corresponded to ours despite variations in setup used by different authors. A wide spectrum of major colorectal surgery can be safely and effectively performed with the Hugo RAS, even in a cohort of non-selected patients. Ongoing software and hardware upgrade, introduction of robotic energy devices and increasing surgical experience are expected to facilitate procedures and reduce duration of surgery.

Keywords: Colorectal surgery; Hugo; Robotic assisted; Setup; Total mesorectal excision.

Fig. 1

Left hemicolectomy and sigmoidectomy: cart setup (A) and trocar position (B)

Fig. 2

Rectal resection, APR and Hartmann’s reversal: cart setup (A) and trocar position (B)

Fig. 3

Right hemicolectomy: cart setup (A), standard trocar position (B) and alternative trocar position (C). C camera trocar, A assistant trocar, LH left hand of surgeon, RH right hand of surgeon, R reserve hand