Robot-assisted radical cystectomy with intracorporeal orthotopic neobladder reconstruction using the Hugo™ RAS: initial experience, optimization curve and perioperative outcomes.
Abstract
Objectives: To evaluate the surgical feasibility, perioperative safety, and early functional renal kinetics of to-tally intracorporeal orthotopic neobladder reconstruction (ICNR) following robot-assisted radical cystectomy (RARC) utilizing the novel modular Hugo™ RAS system.
Methods: We conducted a retrospective analysis of patients who underwent Hugo™ RAS-assisted RARC and ICNR. Procedures were performed using a standardized four-arm configuration with continuous intra-abdominal insufflation targeted at 12 mmHg. Bowel isolation and side-to-side continuity were established laparoscopically via an assistant port. Non-linear smoothing was used to model the surgical learning curve and longitudinal changes in serum creatinine were analyzed using paired t-tests.
Results: Seven patients successfully underwent the procedure without any open or conventional laparoscopic conversions. The cohort had a median age of 70.0 years (IQR: 65.0–72.0) and a high comorbidity status (median Charlson Comorbidity Index: 5.0). The median total skin-to-skin surgical time was 290 minutes (IQR: 245–342), with platform docking requiring a highly reproducible median time of 19.0 minutes (IQR: 17.0–21.0). Nonlinear modeling showed an encouraging operational learning curve, with surgical duration contracting to an absolute low of 200 minutes by the sixth sequence. Median hospital length of stay was 4.0 days. No major high-grade intraoperative or postoperative complications occurred. Longitudinal analysis showed immediate functional renal stability, yielding a uniform net decrease in serum creatinine levels at discharge relative to baseline.
Conclusion: Hugo™ RAS-assisted RARC with fully ICNR is technically feasible, reproducible, and safe. The plat-form’s modular architecture provides efficient multi-quadrant workflows, a surmountable learning curve, and excellent early renal functional preservation.
Keywords: Bladder cancer robot-assisted radical cystectomy, intracorporeal urinary diversion, orthotopic neobladder reconstruction, Hugo RAS system; Learning curve