Medtronic's Hugo™ robotic surgery system for robot-assisted radical prostatectomy: a systematic review of current worldwide experiences

Abstract

Urology's pioneering role in surgical innovations, from cystoscopy to laparoscopic surgery, culminated in the twenty-first-century advent of robotic surgery. The dominant da Vinci^® system faced new competition following its 2019 patent expiration. Medtronic's Hugo^™ system emerged. Its growing global adoption, especially in robot-assisted radical prostatectomy (RARP), necessitates a systematic review, evaluating safety, feasibility, and comparison with established systems. A comprehensive search identified eligible studies of the Hugo^™ robotic platform for RARP, presenting their current experiences. Following systematic screening, quality of eligible studies was assessed using ROBINS-I. Results then underwent a narrative synthesis. This systematic review analysed 19 eligible studies, consisting of 9 comparative and 10 single arm studies. Due to the non-randomised nature of the studies, a moderate risk of bias was concluded in most. On account of the high heterogeneity between studies, a narrative synthesis of data was enacted; categorised into themes relating to operative timings, transfer of skills, patient demographics, plus safety and feasibility. Eligible studies demonstrated the promise of the Hugo^™ platform within these themes, in comparison to currently available platforms. Despite a paucity of high-quality randomised controlled trials, available evidence indicates Hugo^™ as a promising, safe alternative for RARP. Positive experiences across diverse centres and surgeons revealed minimal differences in surgical outcomes compared to the established da Vinci^® system, fostering global Hugo^™ adoption. Despite evidence demonstrating Hugo^™ safety and comparability, the review underscores the scarcity of high-quality evidence, attributing it to early stage implementation challenges.

Keywords: Da Vinci; Hugo; RARP; RAS; Robotic-assisted radical prostatectomy.

Fig. 1

Comparison of console variations between the closed design of da Vinci^® (right) vs open Hugo^™ (left)

Fig. 2

Comparison of patient arm cart setup in da Vinci^® (left) vs Hugo^™ (right), displaying modularity of Hugo^™ RAS

Fig. 3

PRISMA flow diagram summary of the literature search and systematic review process

Fig. 4

Risk-of-bias summary for each study

Fig. 5

Bar chart illustration of risk-of-bias assessment in eligible studies

Fig. 6

Search strategy applied for each database used