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Totaro A, Scarciglia E, Marino F, Campetella M, Gandi C, Ragonese M, Bientinesi R, Palermo G, Bizzarri FP, Cretì A, Presutti S, Russo A, Aceto P, Bassi P, Pierconti F, Racioppi M, Sacco E. Robot-Assisted Radical Prostatectomy Performed with the Novel Surgical Robotic Platform Hugo™ RAS: Monocentric First Series of 132 Cases Reporting Surgical, and Early Functional and Oncological Outcomes at a Tertiary Referral Robotic Center. Cancers (Basel) 2024; 16:1602. [PMID: 38672683 PMCID: PMC11049006 DOI: 10.3390/cancers16081602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Robotic-assisted surgery is the gold standard for performing radical prostatectomy (RARP), with new robotic devices such as HugoTM RAS gaining prominence worldwide. OBJECTIVE We report the surgical, perioperative, and early postoperative outcomes of RARP using HugoTM RAS. DESIGN, SETTING, AND PARTICIPANTS Between April 2022 and October 2023, we performed 132 procedures using the Montsouris technique with a four-robotic-arm configuration in patients with biopsy-proven prostate cancer (PCa). OUTCOME MEASURES We collected intraoperative and perioperative data during hospitalization, along with follow-up data at predefined postoperative intervals of 3 and 6 months. RESULTS AND LIMITATIONS Lymphadenectomy was performed in 25 procedures, with a bilateral nerve-sparing technique in 33 and a monolateral nerve-sparing technique in 33 cases. The mean total surgery time was 242 (±57) min, the mean console time was 124 (±48) min, and the mean docking time was 10 (±2) min. We identified 17 system errors related to robotic arm failures, 9 robotic instrument breakdowns, and 8 significant conflicts between robotic arms. One post-operative complication was classified as Clavien-Dindo 3b. None of the adverse events, whether singular or combined, increased the operative time. Positive margins (pR1) were found in 54 (40.9%) histological specimens, 37 (28.0%) of which were clinically significant. At 3 and 6 months post-surgery, the PSA levels were undetectable in 94.6% and 92.1% of patients, respectively. Social urinary continence was regained in 86% after 6 months. Limitations of our study include its observational monocentric case-series design and the short follow-up data for functional and oncological outcomes. CONCLUSIONS Our initial experience highlights the reliability of the HugoTM RAS system in performing RARP. Additionally, we also list problems and solutions found in our daily work.
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Affiliation(s)
- Angelo Totaro
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Eros Scarciglia
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Filippo Marino
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Marco Campetella
- Department of Urology, Isola Tiberina—Gemelli Isola Hospital, Catholic University Medical School, 00167 Rome, Italy
| | - Carlo Gandi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Mauro Ragonese
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Giuseppe Palermo
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Francesco Pio Bizzarri
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Antonio Cretì
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Simona Presutti
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Andrea Russo
- Department of Anesthesia, Emergency and Intensive Care Medicine, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Paola Aceto
- Department of Anesthesia, Emergency and Intensive Care Medicine, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Pierfrancesco Bassi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Francesco Pierconti
- Department of Pathological Anatomy, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Marco Racioppi
- Department of Urology, Agostino Gemelli Hospital Foundation—IRCCS, Catholic University Medical School, 00167 Rome, Italy
| | - Emilio Sacco
- Department of Urology, Isola Tiberina—Gemelli Isola Hospital, Catholic University Medical School, 00167 Rome, Italy
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Ngu JCY, Lin CCW, Sia CJY, Teo NZ. A narrative review of the Medtronic Hugo RAS and technical comparison with the Intuitive da Vinci robotic surgical system. J Robot Surg 2024; 18:99. [PMID: 38413488 DOI: 10.1007/s11701-024-01838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024]
Abstract
Medtronic launched the Hugo Robotic-Assisted Surgery (RAS) System in 2021, offering a modular alternative to the incumbent market leader in surgical robotics, the Intuitive da Vinci (dV) surgical system. A detailed technical review of the Hugo RAS was conducted to explore the strengths and weaknesses of this new robotic surgical system. Each component of the system-vision tower, arm cart, and surgeon console-was compared against the existing dV systems. The docking process, instrumentation, and external arm movement trajectories were analyzed. The modular Hugo RAS provides the possibility of operating using up to four arm carts. It has certain design features that are unique to itself, and others that have been implemented to address the shortcomings of the dV Si. While Medtronic's first-generation robot offers distinct advantages over the older Intuitive systems, the true test of its mettle will be its performance compared to the latest dV Xi.
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Affiliation(s)
- James Chi-Yong Ngu
- Colorectal Service, Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | | | - Crystal Jin-Yang Sia
- Colorectal Service, Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Nan-Zun Teo
- Colorectal Service, Department of Surgery, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
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Mian AH, Tollefson MK, Shah P, Sharma V, Mian A, Thompson RH, Boorjian SA, Frank I, Khanna A. Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy. J Clin Med 2024; 13:359. [PMID: 38256493 PMCID: PMC10815957 DOI: 10.3390/jcm13020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.
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Affiliation(s)
- Abrar H. Mian
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ahmed Mian
- Urology Associates of Green Bay, Green Bay, WI 54301, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abhinav Khanna
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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