Prospective Comparative Cohort Study of the Initial Learning Curve of Hugo<sup>TM</sup> RAS for Inguinal Hernia Repair by a Proficient da Vinci Robotic Hernia Surgeon: The SUSHI Study.

Abstract

<h4>Background</h4>Robotic-assisted surgery has become increasingly utilized in inguinal hernia repair (r-TAPP), offering enhanced precision and improved ergonomics. Differences in operative efficiency between robotic platforms during the early adoption phase are not well known. This study compares the operative times during the learning curve of r-TAPP using the Hugo^TM RAS and the da Vinci Xi robotic system.<h4>Methods</h4>Patients undergoing r-TAPP with the Hugo^TM RAS were prospectively enrolled (Hugo SUSHI cohort). Data on patient characteristics, operation time, complication rate and quality of life scores were collected and compared to previously prospectively collected data from r-TAPP performed with the da Vinci Xi. All surgeries were performed by the same surgeon.<h4>Results</h4>The first 50 consecutive patients operated with the Hugo^TM RAS (sept 2023 - dec 2024) were included in the study and compared to the first 50 patients operated with the da Vinci Xi (sept 2016 - jan 2017). Mean skin-to-skin operative time was 57.0 min with Hugo™ RAS and 62.8 min with da Vinci Xi (mean difference: 5.9 min; p = 0.09). Among the first 25 cases, skin-to-skin time was significantly shorter with Hugo™ RAS (mean difference: 11.7 min; p < 0.001), but this difference was not observed in the second 25 cases. In the Hugo SUSHI cohort two intraoperative complications occurred, neither of which were procedure related, and at 4-week follow-up 5 patients (10%) presented with an asymptomatic seroma. Postoperative quality of life was significantly improved at 4 weeks.<h4>Conclusion</h4>For a surgeon experienced with the da Vinci platform, transition to the Hugo^TM RAS for r-TAPP was not associated with a measurable learning curve in terms of skin-to-skin operative time.