The last 2 decades have witnessed a significant evolution of the robotic-assisted surgical (RAS) systems,¹ and several novel robotic platforms are emerging as innovative solutions and competitors for leadership in the marketplace.² The Hugo RAS system has recently received CE mark approval for urological procedures, and we previously described our surgical setup with this novel robotic platform, including the first procedure performed in Europe.^3,4 However, data on clinical outcomes of patients operated on with this surgical robot are lacking. For this reason, we describe surgical outcomes of robot-assisted radical prostatectomy (RARP) performed at our institution with the Hugo RAS System.

We analyzed data of 112 patients who received RARP ± extended pelvic lymph node dissection (ePLND) at Onze-Lieve-Vrouwziekenhuis Hospital between February and November 2022. All procedures were performed by experienced robotic surgeons. ePLND was performed in men with a preoperative risk for nodal involvement ≥5%.⁵ Our trocar placement and arm carts disposition in the operative room were previously described.³ RARP was performed with a transperitoneal, anterior approach following validated steps and metrics.^6,7 Monopolar curved shears, bipolar fenestrated grasper, and large needle driver were used in a 3-instrument configuration. Urethral catheter was removed on postoperative day 2.⁸

We described baseline, peri- and postoperative characteristics of our cohort. Urinary continence was defined as the use of no or 1 safety pad. Kaplan-Meier curve assessed time to continence recovery after surgery.

Baseline Characteristics

Median (IQR) age and body mass index were 65 years (60, 70) and 26 kg/m² (24, 29), respectively (Table 1). Median (IQR) preoperative PSA level was 7.9 ng/mL (5.8, 10.7). A total of 38 (34%) patients had ISUP (International Society of Urological Pathology) group ≥3 tumor on prostate biopsy. On preoperative MRI, median (IQR) prostate volume was 40 cc (32, 55), and 26 (23%) patients had a suspicion of extraprostatic disease.

Table 1. Demographic and Clinical Characteristics of the 112 Patients Treated With Robotic-assisted Radical Prostatectomy Performed With the Hugo RAS Robotic Platform

Intra- and Postoperative

Median (IQR) operative and console time were 180 (145, 200) and 150 (110, 175) minutes, respectively (Table 2). No intraoperative complication was recorded. Median (IQR) estimated blood loss was 400 mL (250, 575). A total of 27 (24%) patients received an ePLND. Overall, a total of 9 (8%) patients experienced postoperative complications. Median length of stay was 3 days (IQR: 3, 4).

Final Pathology and Follow-up

On final pathology, 48 (43%), 34 (31%), and 4 (4%) patients had ISUP group 3-5 tumors, evidence of extraprostatic extension, and lymph node involvement, respectively (Table 3). Median (IQR) number of lymph node removed was 15 (9, 19). A total of 10 (9%) patients had positive surgical margins. Among 68 patients with available data on the first PSA after surgery, 60 (88%) had undetectable PSA.

Early Urinary Continence

Data on urinary continence recovery were available for 107 (96%) patients. Median follow-up for patients who did not recover urinary continence after surgery was 40 days (IQR: 29, 85). The 1- and 3-month probabilities of urinary continence recovery were 36% (95% CI: 28%, 47%) and 81% (95% CI: 72%, 89%; see Figure), respectively. Median time to urinary continence recovery was 36 days (95% CI: 34, 44).

Figure. Urinary continence recovery. RARP indicates robot-assisted radical prostatectomy; UC, urinary continence.

In this clinical investigation, we described surgical outcomes of RARP using the novel Hugo RAS system. In this regard, only a few studies are available to date. For instance, Ragavan et al compared outcomes of 17 cases performed with Hugo RAS with those of similar number of patients operated on with da Vinci robots.⁹ They described optimal perioperative outcomes, with operative time consistent with our results. Of note, postoperative PSA was undetectable for all patients, whereas positive surgical margins were found in 23% of men. This is in contrast with our results and, among possible explanations, we acknowledge our technique for apical dissection—the collar technique¹⁰—that allowed us to minimize positive margins rate and that we were able to adequately translate to the novel Hugo RAS platform. That said, the main focus of Ragavan et al was to compare outcomes of patients operated on with different platforms.⁹ Moreover, their study, given the small sample size, included only a few patients with aggressive disease and lacked nerve-sparing surgeries, and as such, it is difficult to draw definite conclusions of surgical outcomes of RARP performed with Hugo RAS. By contrast, we previously described our surgical setup with this new robotic platform,³ and now we were able to assess our perioperative, early oncologic, and functional outcomes in an adequately large cohort that included the entire spectrum of patients receiving surgery for prostate cancer. For these reasons, we are positive that our study provided relevant data on clinical outcomes that followed the introduction of Hugo RAS into the robotic market.

In conclusion, this is the first report of surgical outcomes of RARP executed with the Hugo RAS system. Awaiting future investigations with longer follow-up, this study provides relevant data on perioperative, early oncologic, and functional data of RARP performed with this new robotic platform.