Hugo：多臂手术机器人

Novel Modular Multi-arm Robotic Thoracic Surgery: Early Prospective Evaluation of Safety, Feasibility, and Operative Workflow
Hugo：多臂手术机器人

Objective
HugoTM Robotic-assisted surgery (RAS) System is a novel modular, open-console, multi-arm robotic platform, differing from earlier robotic counterparts that are boom-mounted with immersive console. While its safety and feasibility have been demonstrated in urologic and colorectal procedures, evidence in thoracic applications remains limited.

Methods
A prospective pilot study was conducted at a single tertiary centre from Jun to Oct 2025 to evaluate the safety, feasibility and workflow characteristics of the HugoTM for thoracic procedures. Seven patients underwent sequential learning curve representing genuine learning curve.

Results
There were 5 cases of total thymectomy (subxiphoid 3-port approach in supine position), 1 case of mediastinal lymph node biopsy and another case of right subpleural mass excision (3-port approach in lateral position), all with CO2 insufflation. Mean docking time was 10 minutes (range 5-18), mean undocking time was 2.8 minutes (range 2-5), mean console time was 123 minutes (range 50-167), and mean total procedural time was 191 minutes (range 108-225). There were no intraoperative adverse events or need for conversion. There were no problems with visualization, instrument reach or arm collision for thymectomy cases, but arm collision occurred for the lymph node biopsy case due to port placement issues and was the only case where redocking of arms was required after tilting of bed. Mean blood loss was 13mL, mean duration of drain was 4.2 days while mean hospital stay was 5.4 days. No complications occurred except for 1 patient with transient fever on the first post-operative day. Health-related quality of life as assessed by EQ-VAS scores declined by an average of 5 points postoperatively. All resections achieved negative margins across benign and malignant pathologies.

Conclusions
This is one of the earliest prospective thoracic experiences utilizing a modular multi-arm robotic platform, showing that HugoTM system for mediastinal thoracic surgery is safe and feasible, with no conversions or major complications. Docking and operative times were acceptable within an initial learning curve, while early outcomes and quality-of-life metrics were comparable to established robotic platforms. These preliminary findings support continued evaluation of Hugo™ in thoracic surgery and the refinement of standardized workflows to facilitate broader adoption, while its role in pulmonary resection remains to be validated.

Joyce Chan (1), Aliss Tsz Ching Chang (1), Ivan C.H. Siu (1), Clarence Hui Wah Chan (1), Cindy Cho (1), Junko C.S. Chan (1), Rainbow Lau (1), Calvin Ng (1), (1) Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, NA