Transperitoneal and retroperitoneal robot-assisted partial nephrectomy with the Hugo™ RAS system: Video instructions and initial experience from a tertiary care referral centre

Introduction: To describe operatory room (OR) setting, trocar placement, surgical technique and perioperative outcomes of retroperitoneal (rRAPN) and transperitoneal (tRAPN) robot-assisted partial nephrectomy with the Hugo™ robot-assisted surgical (RAS) system. Patients and surgical procedure: We present our prospective, series of the first ten consecutive patients submitted to either rRAPN or tRAPN with the Hugo™ RAS system (Medtronic, Minneapolis, MN, USA) at ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, between April 2023 and June 2023. The outcomes of interest were to describe the OR setting, trocar placement and the performance of this novel robotic system. Pre, intra and post-operative variables were recorded. A descriptive analysis was performed. Results: Overall, ten patients underwent RAPN with the Hugo™ RAS system, of which two were rRAPN (one left and one right renal mass) and eight tRAPN (two left, five right, one bilateral). Median (interquartile range, IQR) tumor size was 2.75 cm, with a median PADUA score of 7 (7,9). Median time from first trocar placement to console was 20 (15, 23) minutes, median console time was 136 (100, 159) minutes, and median operative time was 185 (170, 232) minutes. No intra-operative complications were recorded. Four post-operative complications were reported: one patient developed acute kidney injury (AKI, Clavien-Dindo 1), one patient required a longer hospital stay due to chylous production from the drain after hilar lymphadenectomy (Clavien-Dindo 2) and two pneumothoraxes (Clavien-Dindo 3a). Median (IQR) hospital stay was 5 (3,7) days. At final pathology, clear cell RCC, papillary RCC, chromophobe RCC and oncocytoma were found in respectively seven (70 %), one (10 %), one (10 %), and one (10 %) patients, with T1a, T1b and T3a (perirenal fat invasion) stages in six (60 %), three (30 %) and one (10 %) patients, respectively. Conclusions: This video article illustrates the steps of both rRAPN and tRAPN with the Hugo™ RAS system. Our preliminary results demonstrate that both rRAPN and tRAPN are feasible with this novel robotic platform. Future large case series with long-term follow-up are needed to understand whether Hugo™ RAS system represents a true alternative to Intuitive platforms for nephron-sparing surgery.