A Novel Port and Arm Placement Strategy for the Hugo Robotic-Assisted Surgery (RAS) System in Gynecologic Oncology: Initial Experience and Technical Considerations.

Introduction: The Hugo robotic-assisted surgery (RAS) system is a novel surgical platform that expands the potential for minimally invasive procedures in gynecologic oncology. Early studies have shown promise, but the optimal configuration of ports and robotic arms requires further clarification. This study aimed to introduce a refined strategy for optimizing port placement and robotic arm arrangement with the Hugo RAS system and compare its performance to previously employed configurations.

Materials And Surgical Technique: Initial experiences in two cases of early-stage endometrial cancer are presented. A new configuration was developed through iterative discussions and a review of emerging Hugo RAS literature. Port placement and arm arrangement with three arms on the patient's right side and one on the left-were designed to expand the assistant's working space. Two patients with stage IA endometrial cancer underwent surgery with this approach. Operative times, blood loss, and procedural details were evaluated.

Discussion: Both procedures were completed successfully with improved instrument articulation, reduced arm collisions, and enhanced workflow. Compared with previous strategies, this new configuration provided better ergonomics, minimized interference between robotic and assistant instruments, and expanded the operative field for both the first and second assistants, enabling smoother transvaginal specimen retrieval. Initial findings suggest that optimizing both port placement and arm settings enhances the surgical environment for the Hugo RAS system and may improve procedural efficiency and patient outcomes. Further studies with larger cohorts are warranted to validate these findings and potentially establish standardized guidelines.