This study evaluates the use of the Hugo RAS system for retroperitoneal robot-assisted partial nephrectomy (rRAPN) in patients with posteriorly located kidney tumors. The Hugo RAS system introduces unique features, including individual robotic arm carts and an open console, enhancing modularity and flexibility in surgical setup. To optimize these features, the surgical team developed a specific retroperitoneal setup to maximize the efficiency of the platform in clinical practice. Between February and October 2023, six patients (four right-side and two left-side rRAPNs) underwent surgery with a four-arm configuration of the Hugo RAS system. Patients were selected based on tumor location, specifically posterior lesions in the mesorenal or lower pole regions.
The surgical procedure involved creating retroperitoneal space with an inflatable balloon trocar, followed by trocar placement for the endoscope and robotic arms, ensuring proper docking angles to prevent arm conflicts. Each surgery used arterial clamping and a double-layer suture technique (3/0 Monocryl for the inner layer and 2/0 Vicryl for the outer layer). The study reported a median tumor size of 3 cm, PADUA score of 8.5, operative time of 170 minutes, and docking time of 6 minutes. The median estimated blood loss (EBL) was 100 ml, and the median warm ischemia time was 16 minutes. Patients had a median hospital stay of 3 days, with only one postoperative complication (a wound infection). Pathology results showed that four lesions were pT1a and two were pT1b, with no positive surgical margins noted.
These findings suggest that the Hugo RAS system’s modular setup is effective for retroperitoneal nephrectomy and can be a valuable addition to robotic renal surgery programs, offering a versatile platform suitable for both transperitoneal and retroperitoneal approaches.
