The Hugo™ RAS system in gynecologic robotic surgery: a systematic review of current applications

Introduction: The Hugo™ Robotic-Assisted Surgery (RAS) system is a recent development in minimally invasive gynecologic surgery. Following regulatory approval, its clinical use has expanded. However, comprehensive evidence on feasibility, safety and surgical outcomes has not been established. This systematic review synthesizes the available clinical data on the application of this robotic system across gynecologic procedures. Materials and methods: A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42024519329), interrogating PubMed, Web of Science and Embase databases. Manuscripts reporting data on patients undergoing gynecologic surgical procedures with the Hugo™ RAS platform were included in the analysis. Results: Qualitative analysis was conducted on twelve studies including 445 patients. Hysterectomy was the main procedure (either total or supracervical; n = 289, 64.9%), with primary indications including fibromatosis (n = 149, 33.5%) and endometriosis (n = 92, 20.7%). Some studies (n = 5, 41.7%) included patients with gynecologic malignancies, mainly endometrial cancer; one reported robotic management of a perivesical recurrence. Few conversions (laparotomy n = 1, 0.22%; laparoscopy n = 5, 1.12%), intraoperative complications (n = 4, 0.90%), and postoperative complications (Clavien-Dindo grade ≥ II, 1.57%) occurred. Weighted mean operative, console and docking times were 141.84 ± 28.73, 97.98 ± 28.13, and 5.90 ± 0.94 min, respectively. Estimated blood loss averaged 110.75 ± 84.16 mL, and mean hospital stay was 2 ± 1 days. Reported system malfunctions were generally manageable without significant clinical consequences. Conclusions: Current evidence indicates that the system can be safely implemented by gynecologic surgeons in routine clinical practice. Nevertheless, further high-quality research is required to determine long-term outcomes and to assess its integration within the evolving landscape of digital surgical technologies.