Robot-assisted partial nephrectomy with the Hugo™ RAS system: Perioperative outcomes from a single-center cohort including moderate-to-highly complex renal masses

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PURPOSE: To evaluate the perioperative and early functional outcomes of robot-assisted partial nephrectomy (RAPN) using the Hugo™ RAS System in a consecutive single-center cohort of patients, including a subgroup of moderate-to-high complexity renal masses. METHODS: We retrospectively analyzed 80 consecutive patients who underwent off-clamp RAPN with the Hugo™ RAS System between October 2022 and October 2024. Tumor complexity was evaluated using the R.E.N.A.L. nephrometry score. Perioperative variables, pathological data, and renal function were collected. The primary endpoint was to explore the safety and feasibility of the Hugo™ RAS System in nephron-sparing surgery. Trifecta achievement was defined as negative surgical margins, no Clavien-Dindo ≥IIIa complications, and ≤30% eGFR decline at discharge. RESULTS: The cohort included 53 males and 27 females, with a median age of 63 years. Median tumor size was 32.5 mm at CT scan; 70% of tumors were classified as cT1a while 36 patients had moderate (score 7-9) or highly complex (score ≥10) renal masses. Median operative time was 105.5 minutes, docking time 4 minutes, console time 53 minutes, and estimated blood loss 200 mL. No conversions or major intraoperative complications were recorded. Overall complication rate was 15%, with 1.3% major complications. Negative surgical margins were obtained in 96.2% of cases. Median eGFR at discharge was comparable to baseline (P = 0.65). Trifecta was achieved in 78.8% of the full cohort. CONCLUSIONS: RAPN using the Hugo™ RAS System is a feasible and safe option for the management of renal masses, including complex cases. The platform demonstrated preliminary favorable perioperative outcomes, low complication rates, and satisfactory preservation of renal function even in a moderate-to-highly complex setting.

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