Port placement and patient-specific docking strategies for robotic hysterectomy with the Hugo™ RAS system: an international Delphi consensus

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Background: Robotic-assisted hysterectomy is increasingly performed using modular platforms such as the Hugo™ roboticassisted surgery (RAS) system, but optimal or personalised docking strategies remain undefined. Objectives: To establish expert consensus on port placement and docking configurations for hysterectomy with the Hugo™ RAS system and to identify patient anthropometric factors requiring modification of standard setups. Methods: A modified Delphi consensus was conducted involving two iterative rounds of anonymous, structured questionnaires distributed to an international panel of gynaecological robotic surgeons experienced with the Hugo™ RAS system. Survey items addressed preferred docking configurations, the influence of patient anthropometry on docking strategy, and specific technical adjustments in non-standard scenarios. Consensus was predefined as ≥66.7% agreement. Main Outcome Measures: Expert agreement on docking setups, port placement modifications, and anthropometric variables influencing technical adjustments. Results: Seventeen experts completed round one and 16 completed round two. No single docking configuration reached consensus as universally optimal for standard hysterectomy. Ranking exercises identified the "standard" hysterectomy setup as the most preferred configuration, followed by the "alternate" and the "three-arm" setups. All experts agreed that patient anthropometry requires modification of port placement. Elevated body mass index (BMI), large uterine size and small pelvis were identified as key variables: increasing inter-port distance was recommended for BMI >30, cranial port displacement for large uteri, while no consensus emerged for patients with a small pelvis. A modified bridge configuration was proposed, and achieved strong expert agreement. Conclusions: No single docking configuration is deemed to be universally optimal for Hugo™ RAS hysterectomy. Expert practice combines a limited number of preferred setups with patient-tailored adjustments. What is New?: This study provides the first Delphi-based expert consensus on Hugo™ RAS docking strategies, emphasizing patient-specific adjustments and flexible preoperative planning.

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