First reported robotic pancreaticoduodenectomy using the Hugo™ RAS system: feasibility and safety

Background: Pancreaticoduodenectomy (Whipple procedure) is among the most demanding operations in HPB surgery. Early diagnosis and meticulous perioperative optimization, combined with recent technical advances, especially robotic platforms, are key contributors to improved postoperative outcomes. Robotic pancreaticoduodenectomy (RPD) may enhance dexterity and ergonomics in complex HPB procedures. The Hugo™ Robotic-Assisted Surgery (RAS) system has recently entered clinical practice, yet RPD on this platform has not been reported. Methods: We describe a single-center, first reported case of RPD using the Hugo™ RAS system. Preoperative evaluation, OR layout, port mapping, arm configuration, instruments, docking strategy, and stepwise operative workflow are detailed. Primary endpoints were technical feasibility and intra/perioperative safety. Secondary endpoints included operative time, estimated blood loss (EBL), conversion, 30-day complications (Clavien–Dindo), length of stay, and pathology concerning oncological principles. Results: The procedure was completed robotically without conversion. Docking time was 4 min 35 s and console time 5 hours 14 min, EBL 200 mL. No high-priority system alarms or device-related adverse events occurred. Final pathology showed pT1 Duodenal Gastro-Intestinal Stroma Tumour (GIST), tumor size 1,8*1,4*1,4 cm, R0 resection, and 10 lymph nodes retrieved. Postoperative course was notable. Hospital discharge on postoperative day 7 with no postoperative pancreatic fistula (ISGPS), no delayed gastric emptying (ISGPS), and no readmission within 30 days. Conclusion: RPD using the Hugo™ RAS system was feasible and safe in this first reported case, with a reproducible setup and workflow. These findings support further prospective evaluation and standardization of RPD on this platform.