Surgical Technique and Perioperative and Postoperative Outcomes for Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion Performed with the Hugo RAS Robotic Platform: First Large Case Series by the European Association of Urology Robotic Urology Section Scientific Working Group

Background and objective: The Hugo RAS robotic platform has shown promising results for urological surgical procedures, but there is a lack of data on robot-assisted radical cystectomy (RARC). Our aim was to describe the surgical technique for RARC performed with the Hugo RAS robot and to assess perioperative and postoperative outcomes. Methods: We identified 29 patients who underwent RARC with lymph node dissection and intracorporeal urinary diversion (IUD) performed with a Hugo RAS robot at five centers between February 2023 and June 2024. An intraoperative video was recorded to show the surgical technique. Data for intraoperative and 90-d postoperative complications were collected according to the European Association of Urology recommendations. Key findings and limitations: In the cohort of 29 patients, 21 (72%) were male and 19 (68%) had a muscle-invasive tumor on clinical evaluation. Nerve-sparing surgery was performed in four men and pelvic organ–preserving procedures in six women. Orthotopic diversion was performed in 14 patients (48%). The median hospital stay was 7 d and median operative time was 279 min. Four patients (14%) had intraoperative complications and 12 (41%) had an any-grade postoperative complication, of which three (10%) were of high grade (Clavien-Dindo grade >2). The most common complications were urinary tract infection (n = 9, 31%), ileus (n = 6, 21%), and anemia requiring transfusion (n = 4, 14%). Conclusions and clinical implications: Our results demonstrate the safety and feasibility of the Hugo RAS robotic platform in performing RARC with IUD. Perioperative and postoperative outcomes were comparable to those reported for established robotic systems, without the need for platform-specific modifications. Patient summary: We looked at bladder cancer surgery using the new Hugo RAS robotic system in a group of 29 patients. The surgery was safe and effective, with outcomes similar to those seen with more established robotic systems. Our results suggest that this new robot is a reliable surgical option for bladder removal.