Robot‐assisted partial nephrectomy using the Hugo™ RAS System: first multicentre study and Tetrafecta achievement

Abstract

OBJECTIVE: To evaluate the perioperative outcomes and the rate of Tetrafecta achievement in robot-assisted partial nephrectomy (RAPN) cases performed using the Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA). PATIENTS AND METHODS: Data from five tertiary care referral centres performing RAPN with the Hugo RAS System since October 2022 were collected. For the study purpose, a novel Tetrafecta was defined as a proxy for surgical quality. This included the coexistence of negative surgical margins, absence of intraoperative and Clavien-Dindo Grade ≥II postoperative complications, and 90-day decline in estimated glomerular filtration rate of no more than 30% from baseline. RESULTS: A total of 140 patients, who underwent RAPN with the Hugo RAS system, were included. The median (interquartile range [IQR]) docking, console, and total operative times were 5 (4-7) min, 79 (45.5-135) min, and 150 (96-205) min, respectively. The median (IQR) estimated blood loss was 150 (100-300) mL. No additional port placements were required, and no conversions to open surgery occurred. Overall, postoperative complications were observed in 20.7% of cases, 5% of which were classified as major (Clavien-Dindo Grade >II). Tetrafecta was achieved in 80% of cases. Multivariate logistic regression analysis showed that R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness to collecting system or sinus, Anterior/Posterior, Location) nephrometry score (odds ratio [OR] 0.69; P = 0.01) and Hugo RAS surgical experience (OR 1.03; P = 0.02) were independent predictors of Tetrafecta achievement. CONCLUSIONS: Relying on the largest multicentre series, our findings demonstrate that this novel robotic platform enables safe and effective RAPN, achieving a satisfactory Tetrafecta rate. These results would support the adoption of the Hugo RAS system to perform RAPN.