Introduction: New surgical robots with various technical enhancements are gaining popularity in urology and may increase the use of robotics also in non-oncological fields. HUGO RAS system is a robotic platform with independent arm carts and an open console. Here, we presented our first robot-assisted pyeloplasty with HUGO RAS system with the aim to describe technical feasibility and surgical setup of this novel robotic platform for benign kidney surgery. Methods: A 36-year-old male, without previous abdominal surgeries, was diagnosed with a left pyeloureteral junction stenosis. The CT scan showed a left kidney hydronephrosis with a pelvis diameter of 6 cm with a delayed urinary excretion. The MAG-3 scan showed left and right renal function of 27% and 73%, respectively. A robot-assisted left pyeloplasty was performed through a transperitoneal approach with the HUGO RAS system. With the patient in right lateral decubitus, a 12-mm Airseal trocar was placed 2 cm lateral to the umbilicus, on the left pararectal line. Other two 8-mm robotic ports and an 11-mm optic port were placed under vision in a diamond configuration (Figure 1), all of them 8 cm apart from each other and 2 cm away from bone prominences; lastly, an 8-mm port was placed in the left lower quadrant. In order to optimise working space, three arm carts (corresponding to surgeon’s left hand, optic and forth robotic arm, respectively) were positioned behind the operative bed, whereas one arm cart (i.e. surgeon’s right hand) was placed in front of the patient. Results: The patient was classified as ASA 1 and had a preoperative creatinine of 1.16 mg/dl. Operative and console time were 95 and 70 minutes, respectively. No intraoperative complications occurred, and blood loss was <20 cc. No technical problems, instruments or arms clashes were reported. The patient was discharged the second postoperative day with a creatinine of 1.02 mg/dl. No perioperative complications were reported. Conclusions: Robot-assisted pyeloplasty using the new HUGO RAS system is safe, feasible and it guarantees optimal perioperative and early functional outcomes. Awaiting study with longer follow-up, our data showed that HUGO RAS might be considered a valuable treatment option for benign kidney surgery, providing relevant information for future adopters of this surgical platform. SOURCE OF Funding: None
