# Robotic subtotal gastrectomy with Hugo™ robotic-assisted surgery (RAS) system: first report on a case series

## TL;DR

This paper reports the first use of the Hugo™ robotic system for subtotal gastrectomy in gastric cancer patients, showing it is feasible and safe with good short-term outcomes.

## Contribution

First clinical case series using the Hugo™ robotic system for subtotal gastrectomy with D2 lymphadenectomy in gastric cancer.

## Key findings

- All four subtotal gastrectomies with D2 lymphadenectomy were completed successfully without conversion.
- Standardized port setup and available instruments enabled safe and reproducible procedures without energy devices.
- Short-term outcomes suggest feasibility of Hugo™ RAS in upper gastrointestinal oncologic surgery.

## Abstract

Robotic-assisted surgery (RAS) has increasingly gained interest in gastric cancer treatment due to its enhanced precision and vision. Hugo™ RAS is a novel system designed to improve accessibility and reduce costs. However, its use in oncologic upper gastrointestinal procedures is still scarcely documented.

We report four consecutive cases of subtotal gastrectomy with D2 lymphadenectomy performed using Hugo™ RAS at a single institution. Patients were selected following multidisciplinary evaluation and underwent full robotic procedures with standardized port placements. Intraoperative parameters, complications, and short-term oncologic outcomes were analyzed.

All procedures were completed successfully without conversion or major complications. Median docking and console times were within acceptable limits, though longer than traditional laparoscopy due to system learning curve and intraoperative frozen section use. Lymphadenectomy was adequate in all D2 cases with R0 resection achieved. No blood transfusions were needed. Postoperative complications included delayed gastric emptying and a duodenal stump leak. The system proved safe, and the procedural setup did not require modifications from laparoscopic standards.

Subtotal gastrectomy with D2 lymphadenectomy using Hugo™ RAS is feasible and safe. The standardized setup and available instruments support oncologic adequacy without energy devices. Further studies are needed to validate long-term outcomes and assess comparative advantages over conventional approaches.

•First report on subtotal gastrectomy using Hugo™ RAS in gastric cancer•Standardized port setup enabled safe and reproducible procedures•Effective Roux-en-Y reconstruction achieved without energy devices•Hugo™ RAS supported adequate lymphadenectomy and R0 resections•Short-term outcomes suggest feasibility in upper GI oncologic surgery

First report on subtotal gastrectomy using Hugo™ RAS in gastric cancer

Standardized port setup enabled safe and reproducible procedures

Effective Roux-en-Y reconstruction achieved without energy devices

Hugo™ RAS supported adequate lymphadenectomy and R0 resections

Short-term outcomes suggest feasibility in upper GI oncologic surgery