Retroperitoneal Renal Surgery with the Hugo™ RAS System: Feasibility, Setting and Perioperative Outcomes of the First Dedicated Series

Objectives: To describe the surgical setup, docking strategy, and perioperative outcomes of retroperitoneal renal surgery performed with the Hugo™ RAS system, reporting, to our knowledge, the first dedicated surgical series. Methods: Between February and August 2025, 30 consecutive patients underwent retroperitoneal renal surgery with the Hugo™ RAS system at a single institution. Procedures included robot-assisted partial nephrectomy (RAPN, n = 15) and robot-assisted pyeloplasty (n = 15), performed by a single experienced surgeon. A standardized retroperitoneal access and reproducible trocar configuration were adopted. A three-arm configuration with predefined docking and tilt angles was used. Feasibility was defined as completion of the procedure without conversion to open or transperitoneal surgery. Perioperative data were prospectively collected and reported as median and interquartile range (IQR). Results: All procedures were completed without conversion or additional trocar placement. In the RAPN cohort, median docking time was 5 min (IQR 5–5), operative time was 180 min (IQR 172–200), and estimated blood loss was 200 mL (IQR 150–250). Three patients (20%) experienced Clavien–Dindo grade II complications; no major complications occurred. Positive surgical margins were observed in 1 patient (6%), with no radiological recurrence at 6-month follow-up. In the pyeloplasty cohort, operative time was 150 min (IQR 147–180) and estimated blood loss was 70 mL (IQR 50–100). One patient (7%) developed a grade II complication. Renal function remained stable in both groups. Conclusions: Retroperitoneal renal surgery using the Hugo™ RAS system is feasible, safe, and reproducible when supported by a standardized docking and port configuration.