EP430 - Robotic oncologic colorectal surgery using the novel HugoTM Robotic Assisted Surgery system: the first North American series

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Purpose/Background: The Medtronic Hugo Robot-Assisted Surgery (RAS) system was recently certified for clinical use in North America, with the first clinical application in colorectal surgery at the University Health Network (UHN) in Toronto, Canada in late 2023. This novel robotic platform utilizes an open console and a modular design with four independent robotic arms, which could offer potential advantages for multi-quadrant abdominal and allowing surgeons to tailor docking configurations. This study describes the largest series of colorectal/gastrointestinal oncology cases performed using the Hugo RAS. We show efficacy of a dual docking technique, safety and clinical outcomes.

Methods/Interventions: This is a retrospective review of 13 colorectal procedures performed using the Hugo RAS platform at UHN between June 2023 and June 2024. Surgeries were performed by three robotically trained surgeons specializing in colorectal surgery/GI surgical oncology.

Results/Outcomes: The Hugo RAS platform presented some challenges in our real-world surgical experience requiring modifications to the detailed Medtronic-tested docking configurations for splenic flexure mobilization and deep pelvic surgery to avoid internal and external arm collisions and reach all anatomical quadrants. Of the 13 cases performed, 9 were for colorectal or anal malignancies and 3 were for complex diverticular disease. The most common procedure was low anterior resection (n=9), abdominoperinal resection (n=2), and anterior resection (n=2). The median BMI was 27.1 kg/m2, and most patients presented with an ASA score of 3. Median console time was 129 min (range, 78-269 min),and median docking time 7 min (range, 3:03-14 min). There were no conversions to laparoscopic or open, and no intraoperative complications. All TME specimens were complete. Median duration of hospital stay was 6 days. Postoperative complications occurred in 3 patients, including ileus, aspiration pneumonia and one patient requiring re-operation for a large pelvic hematoma.

Conclusion/Discussion: This study describes the largest series of colorectal oncology surgeries in North America at a tertiary referral centre performed using the Hugo RAS. Using our institution’s dual docking technique, the Hugo RAS has been shown to be both safe and effective in colorectal procedures. More experience is required in order to streamline docking setup and improve usability.