# Multicenter international experience with the Hugo™ RAS platform in colorectal surgery: reproducibility and real-world outcomes from the COLOROBOT IBERICA study

## TL;DR

This study evaluates the Hugo™ RAS system's performance in colorectal surgery across multiple centers, showing it is safe and effective with low complication rates.

## Contribution

Provides real-world, multicenter data on the Hugo™ RAS system's reproducibility and outcomes in colorectal surgery.

## Key findings

- The Hugo™ RAS system showed low conversion rates and acceptable morbidity in colorectal surgery.
- Anticoagulation and neoadjuvant therapy were linked to increased complications and anastomotic leakage.
- No robot-related setup factors were associated with complication severity.

## Abstract

Robotic-assisted surgery has become increasingly relevant in colorectal procedures, particularly with the emergence of new modular platforms. Multicenter real-world data on the Hugo™ Robotic-Assisted Surgery (RAS) system remains limited. The COLOROBOT IBERICA study is a multicenter retrospective analysis including 285 consecutive patients who underwent elective robotic colorectal surgery using the Hugo™ RAS system between April 2023 and December 2024 across six centers in Spain and Portugal. Demographic data, intraoperative variables, and postoperative outcomes were analyzed. Complications were graded according to the Clavien–Dindo classification, and multivariable analyses were performed to identify predictors of operative time and adverse outcomes. A total of 285 patients were included (median age 69 years; 53% male). Median total operative time was 210 min (IQR 160–243), with a median docking time of 6 min (IQR 5–9) and a median console time of 121 min (IQR 95–146). Estimated blood loss was ≤ 500 mL in 92% of cases. Conversion rate was 1.1%. Overall postoperative complications occurred in 19.2% of patients, with major complications (Clavien–Dindo ≥ III) in 8.0%. Anastomotic leakage occurred in 5.6%, and 4.5% of patients required reintervention. Anticoagulation and neoadjuvant therapy were independently associated with increased morbidity and anastomotic leakage. No robot-related setup factors were associated with complication severity. In this large multicenter real-world cohort, the Hugo™ RAS platform enabled safe, effective, and reproducible colorectal surgery with low conversion rates and acceptable morbidity across different institutions and surgeon profiles. These findings support the scalable integration of modular robotic technology into routine colorectal practice.