Comparative outcomes of Hugo™ robotic and laparoscopic sacrocolpopexy in a high-volume tertiary center: a propensity-matched study.

Abstract

<h4>Objective</h4>Minimally invasive sacrocolpopexy (SCP) is regarded as the gold standard procedure for treating Pelvic Organ Prolapse (POP). Robotic-assisted surgery has emerged as a solid alternative to laparoscopy. Recently, novel platforms have been introduced, including the Hugo RAS (MEDTRONIC Inc, USA), a modular system featuring independent bedside units and an open-designed console. Although solid evidence has shown comparable outcomes between RAS and laparoscopy, there is still limited evidence on the safety and feasibility of novel multi-arm robotic platforms.<h4>Design</h4>We conducted a retrospective study analyzing data from 450 patients undergoing minimally invasive SCP (May 2022-December 2023), using propensity score matching to correct for treatment selection bias. The primary aim was to assess differences in 30-day Clavien-Dindo grade ≥ II complications, Secondary outcomes included intraoperative complications, estimated blood loss, operative time, length of hospital stay, and functional outcomes, to assess overall safety, feasibility, and outcomes of laparoscopic versus robotic-assisted SCP performed with the Hugo RAS system.<h4>Setting</h4>All patients underwent minimally invasive SCP at Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.<h4>Participants</h4>After excluding patients with missing data or incomplete follow-up and PSM, 284 patients were compared, 142 who underwent laparoscopic SCP and 142 who underwent robotic SCP with the Hugo™ RAS system.<h4>Intervention</h4>The study aims to compare laparoscopic and robotic SCP performed with the Hugo™ RAS platform.<h4>Results</h4>Short- to mid-term outcomes were compared. RAS did not significantly differ from laparoscopy in terms of intra- or post-operative complications and length of hospitalization. The robotic group showed a slightly longer operative time and slightly lower intraoperative blood loss. The mean follow-up was 18 months (range 12-36) and a statistically significant improvement of objective and subjective outcomes was reported in both populations, with high satisfaction rate.<h4>Conclusions</h4>The Hugo™ RAS system resulted safe and effective to perform SCP for symptomatic POP, representing a feasible alternative to laparoscopy. These findings support its use as an alternative for the treatment of symptomatic POP and contribute to expanding the evidence for newer robotic platforms in urogynecologic and reconstructive pelvic surgery.