Splenic flexure resection with Hugo™ RAS: Trocar placement, docking settings, and surgical strategy

Introduction: Robotic surgery has been widely adopted in colorectal surgery worldwide over the last decade, but it is still associated with significant cost. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures using newer robotic platforms. This study aims to present the first case series of colonic splenic flexure resection with the novel platform robotic-assisted surgery (RAS) Hugo™. Tips for effective setup of the system and detailed configuration of tilt and docking angles are also provided. Methods: Three cases of colonic splenic flexure resection with Hugo RAS™ system are reported. OR setup and port placement allowing for a full robotic resection were used to perform vascular ligation, colonic splenic flexure mobilization, and side-to-side linear intracorporeal anastomosis, without the need for re-docking. Results: Mean docking time was 11 (range 8–14) minutes and the median total operating time was 243 (range 180–350) minutes. Mean estimated blood loss was 116 (range 50–300) mL. No intraoperative complications or conversions were observed. One patient developed postoperative pneumonia. Conclusions: Total robotic splenic flexure resection with Hugo™ RAS system is feasible with good postoperative outcomes. Further studies are needed to confirm our results and to evaluate the surgical strategy and setup.