Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: 100 consecutive cases, 1-year follow-up and surgical learning curve evaluation

Abstract

The Hugo™ Robotic-Assisted Surgery (RAS) system is an emerging robotic platform; evidence on its performance for extraperitoneal robot-assisted radical prostatectomy (eRARP) remains limited. Between June 2023 and September 2024, 100 patients with prostate cancer underwent eRARP using the Hugo™ RAS system. Preoperative, intraoperative, pathological and postoperative data were collected prospectively. To assess temporal trends related to platform adoption, the cohort was divided into the first 50 and last 50 cases and learning-curve dynamics were analyzed (including CUSUM for console time). We report 12-month follow-up. Across the entire series, the median operative duration was 252.5 min (Q1-Q3 200-290), with no instances of intraoperative conversion or intraoperative complications. Major postoperative events classified as Clavien-Dindo grade III or higher were observed in 2% of patients. At the 12-month assessment, an undetectable PSA (< 0.1 ng/mL) was documented in 80% of individuals, social continence (≤ 1 pad per day) in 87%, and erectile function recovery in 51%. Overall positive surgical margin (PSM) rate was 40%, with clinically significant PSM (≥ 3 mm or multifocal) of 21%. Comparison of two groups revealed a learning effect: median operative time decreased from 275 to 210 min (p < 0.00001); docking time improved modestly (p = 0.0271). Both clinically significant PSMs (28%→14%) and overall complication rates (26%→4%, p = 0.0006) declined in the second cohort. In this prospective, single-center series, eRARP using the Hugo™ RAS system was feasible and safe. A learning-curve effect produced substantially shorter operative times and fewer complications, while oncological and functional outcomes were preserved. Longer follow-up and larger multicenter studies are needed to verify long-term equivalency with well-established robotic platforms.

Keywords: Extraperitoneal radical prostatectomy; Hugo RAS; Learning curve; Prostate cancer; Robotic surgery; Surgical outcomes.