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| Robot-assisted oncologic pelvic surgery with Hugo™ robot-assisted surgery system: A single-center experience |
Angelo Territo,Alessandro Uleri*( ),Andrea Gallioli,Josep Maria Gaya,Paolo Verri,Giuseppe Basile,Alba Farré,Alejandra Bravo,Alessandro Tedde,Óscar Rodríguez Faba,Joan Palou,Alberto Breda
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| Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain |
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Abstract Objective: To report the outcomes of intra- and extra-peritoneal robot-assisted radical prostatectomy (RARP) and robot-assisted radical cystectomy (RARC) with Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA). Methods: Data of twenty patients who underwent RARP and one RARC at our institution between February 2022 and January 2023 were reported. The primary endpoint of the study was to report the surgical setting of Hugo™ RAS system to perform RARP and RARC. The secondary endpoint was to assess the feasibility of RARP and RARC with this novel robotic platform and report the outcomes. Results: Seventeen patients underwent RARP with a transperitoneal approach, and three with an extraperitoneal approach; and one patient underwent RARC with intracorporeal ileal conduit. No intraoperative complications occurred. Median docking and console time were 12 (interquartile range [IQR] 7-16) min and 185 (IQR 177-192) min for transperitoneal RARP, 15 (IQR 12-17) min and 170 (IQR 162-185) min for extraperitoneal RARP. No intraoperative complications occurred. One patient submitted to extraperitoneal RARP had a urinary tract infection in the postoperative period that required an antibiotic treatment (Clavien-Dindo Grade 2). In case of transperitoneal RARP, two minor complications occurred (one pelvic hematoma and one urinary tract infection; both Clavien-Dindo Grade 2). Conclusion: Hugo™ RAS system is a novel promising robotic platform that allows to perform major oncological pelvic surgery. We showed the feasibility of RARP both intra- and extra-peritoneally and RARC with intracorporeal ileal conduit with this novel platform.
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Received: 01 March 2023
Available online: 20 October 2023
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Corresponding Authors:
*E-mail address: alessandrouleri@outlook.it (A. Uleri).
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Trocar placement in RARP. In case of extraperitoneal RARP, the endoscope trocar was placed sub-umbilically (red line); in case of transperitoneal RARP, the endoscope trocar was placed supra-umbilically (blue line). RARP, robot-assisted radical prostatectomy.
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Trocar placement in robot-assisted radical cystectomy.
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Carts positioning and DAs in case of pelvic surgery with Hugo? robot-assisted surgery system. (A) Operating room setting with carts disposition, DAs, and tilt inclination of the robotic arms; (B) DA defined as the angle between the cart and the bed; (C) Tilt defined as the angle between the cart and the first part of the robotic arm. DA, docking angle.
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Intraoperative view of Hugo? robot-assisted surgery system. (A) Closure of dorsal venous complex during an extraperitoneal RARP; (B) Dissection of the prostate apex during a transperitoneal RARP; (C) Wallace type 1 urinary derivation during robot-assisted radical cystectomy. RARP, robot-assisted radical prostatectomy.
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| Variable | Result | | Patient, n | 17 | | Agea, year | 64 (59-69) | | BMIa, kg/m2 | 27 (24-27) | | PSAa, ng/mL | 6.4 (5.1-9.4) | | ISUP grade group at biopsya | 2 (2-3) | | Prostate volume at MRIa, mL | 35 (30-56) | | ECE at MRIb | 2 (11.8) | | Positive DREb | 7 (41.2) | | Docking timea, min | 12 (7-16) | | Console timea, min | 185 (177-192) | | Postoperative complicationb | | | Pelvic hematoma (CD Grade 2) | 1 (5.9) | | UTI that required antibiotic treatment (CD Grade 2) | 1 (5.9) | | Pelvic bleeding that required a TAE (CD Grade 3a) | 1 (5.9) | | Estimated blood lossa, mL | 200 (150-250) | | Length of hospital staya, day | 3 (2-4) | | ISUP grade group at final pathologyb | | | ISUP 1 | 1 (5.9) | | ISUP 2 | 9 (52.9) | | ISUP 3 | 5 (29.4) | | ISUP 4 | 0 (0) | | ISUP 5 | 2 (11.8) | | T stage at final pathologyb | | | pT2 | 14 (82.4) | | pT3a | 3 (17.6) | | Positive surgical marginb | 5 (29.4) | | Postoperative PSA at 3 monthsa, ng/mL | 0.009 (0.006-0.045) |
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Preoperative, intraoperative, and postoperative characteristic of patients treated with transperitoneal robot-assisted radical prostatectomy.
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| Characteristic | Patient | | No. 1 | No. 2 | No. 3 | | Age, year | 65 | 62 | 56 | | BMI, kg/m2 | 27 | 24 | 26 | | PSA, ng/mL | 4.4 | 30.0 | 5.4 | | ISUP grade group at biopsy | 2 | 2 | 1 | | Prostate volume at MRI, mL | 46 | 55 | 34 | | ECE at MRI | 0 | 0 | 0 | | DRE | Negative | Negative | Positive | | Docking time, min | 20 | 15 | 10 | | Console time, min | 200 | 170 | 155 | | Postoperative complications | 0 | UTI (CD Grade 2) | 0 | | Estimated blood loss, mL | 150 | 250 | 100 | | Length of hospital stay, day | 3 | 3 | 4 | | ISUP grade group at final pathology | 3 | 3 | 2 | | T stage at final pathology | 2 | 3a | 2 | | Positive surgical margin | 0 | 1 | 0 | | Postoperative PSA at 3 months, ng/mL | 0.002 | 0.180 | 0.003 |
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Preoperative, intraoperative, and postoperative characteristic of patients treated with extraperitoneal robot-assisted radical prostatectomy.
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