First experience with the Hugo™ robot-assisted surgery system for endometriosis: A descriptive study

Optimizing arm placement in the Hugo™ RAS system-based hysterectomy: development and validation of a simplified "Narrow setting" approach

We aimed to determine the usefulness of the new setup, the "Narrow setting," by examining our initial experience with the Hugo™ RAS system. 78 hysterectomies using the Hugo™ RAS system performed in "Narrow setting" at our institution from November 2023 to December 2024 were included in this study. We retrospectively examined the patient's clinical information and surgical outcomes from the medical record. We also investigated the learning curve of docking time in this setting by cumulative summation analysis. The median age, body mass index, and uterine weight of the patients were 48 (31-76) years, 22.9 kg/m2 (16.1-42.4), and 178 g (40-2000 g), respectively. More than half of the surgical indications were uterine myomas (52.6%, 41/78). The median operative, console, and docking times were 68 min (48-198 min), 46 min (29-151 min), and 9 min (6-31 min), respectively. The median estimated blood loss was 5 mL (5-220 mL). A total of eight perioperative complications were observed, but only one was classified as Clavien-Dindo grade III or higher. No conversion to open or laparoscopic surgery was required. The learning curve for docking time showed that docking in the "Narrow setting" can be proficient in 19 cases. We reported on our initial experience with hysterectomy using the Hugo™ RAS system and found the "Narrow setting" to be safe and efficient.

Clash of the Titans: the first multi-center retrospective comparative study between da Vinci and Hugo™ RAS surgical systems for the treatment of deep endometriosis

BACKGROUND

The proliferation of several robotic platforms presents an opportunity to pinpoint the most suitable system for specific procedures and patient profiles. This study aims to explore differences in complications and functional outcomes among patients undergoing deep endometriosis excision with the da Vinci surgical system compared to the Hugo™ RAS system.

METHOD

This is a retrospective, multicenter cohort study. Patients were categorized based on the surgical system used: the Da Vinci system and the Hugo™ RAS system. Perioperative complications, functional outcomes (via validated questionnaire: BFLUTS, KESS, GIQLI), and pain symptoms both before and after surgery were compared between the two groups.

RESULTS

A total of six postoperative complications were reported: four in the Da Vinci system group (20%) and two in the Hugo™ RAS system group (12.5%). No difference in the mean operative time (p = 0.647), median estimated blood loss (p = 0.179), and hospital stay (p < 0.0001) was found between the two groups. A significant difference was reported in questionnaire score changes and dyspareunia severity in the da Vinci system arm.

CONCLUSIONS

Both robotic systems offer comparable performances in terms of intraoperative complications, although there was a higher incidence of postoperative complications in patients who underwent surgery with the Da Vinci system. Moreover, there was an improvement in dyspareunia, urinary, and gastrointestinal function in the same group.

Novel Minimally Invasive Surgical Approaches to Endometriosis and Adenomyosis: A Comprehensive Review

Endometriosis and adenomyosis are chronic gynecological conditions that significantly impact women's quality of life, leading to symptoms such as pelvic pain, dysmenorrhea, and infertility. Despite ongoing research, a definitive cure for these conditions remains elusive, and treatment often focuses on managing symptoms. Minimally invasive surgery is considered the gold standard for surgical management, but novel surgical techniques are continuously being developed to enhance outcomes. These innovations aim to reduce disease recurrence, improve fertility rates, and provide better long-term symptom relief. In addition, techniques like robot-assisted laparoscopy (RAS) have revolutionized the treatment of complex cases, such as deep infiltrating endometriosis (DIE), offering improved precision and effectiveness. This review explores the latest advancements in surgical approaches, their clinical efficacy, and future directions, emphasizing the need for individualized multidisciplinary care to optimize patient outcomes.

Design and validation a minimally invasive robotic surgical instrument with decoupled pose and multi-DOF

High-performance miniature surgical instruments play an important role in complicated minimally invasive surgery (MIS). Based on in-depth analysis of the requirements of MIS and the characteristics of the existing minimally invasive surgical instruments, a multiple degrees of freedom (DOF) robotic surgical instrument with decoupled pose was proposed. Firstly, the design concept of the pose decoupling instrument was described in detail, and its physical structure, transmission structure, and mechanical properties were designed and analyzed. A surgical instrument control algorithm based on the master-slave mode was established. Finally, a physical prototype was developed, and its motion ranges of joints, load capacity, and suture operation performance were comprehensively evaluated, which confirmed the effectiveness of the proposed minimally invasive robotic surgical instrument.

Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward?

Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole cytoreductive approach. Laparoscopic excision of endometriosis was proven to be beneficial in improving the postoperative pain and fertility. Moreover, it was also proved to be safe and efficient in treating the visceral localization of deep endometriosis, such as urinary and colorectal endometriosis. More recently, robotic-assisted surgery gained attention in the field of endometriosis surgery. Although the robotic technology provides a 3D vision of the surgical field and 7-degree of freedom motion, the safety, efficacy, and cost-effectiveness of this approach are yet to be determined. With this paper, we aim to review the available evidence regarding the role of robotic surgery in the management of endometriosis along with the current practices in the field.