Two procedures.
One synchronous operation.

A Hugo™ Robotic-Assisted Surgery system case study

The flexibility of the Hugo™ Robotic-Assisted Surgery (RAS) system enabled a cross specialty surgical team at Sant'Orsola Hospital in Bologna, Italy to perform a right hemicolectomy and a left full nephrectomy in the same procedure.

"We had extensive experience doing these procedures laparoscopically, but we felt using our Hugo™ RAS system would allow us to do the exact same operation in a less invasive way."

- Prof. Matteo Rotolli 

A robotic procedure offered advantages

Professor Rotolli explained that the flexibility offered by the Hugo™ RAS independent arm carts allowed him to position his access ports and have the instruments coming from the same sides as he traditionally used doing this procedure laparoscopically. This way, he says, “we don’t have to adapt to what the robotic platform needs, we can adapt the robotic platform to our expertise.” He added, “using a robotic system gives us an additional hand to what we can do laparoscopically, and the high-resolution 3D visualization allows us to be more accurate when we are working close to critical anatomical structures.”

Designing a unique approach

Since this was a first-time combined procedure, the team had important planning decisions to make. The surgeons decided to perform the total nephrectomy first due to the patient’s position and to avoid encountering the contamination that would be inevitable in the subsequent colon procedure.

For nephrectomies, urologists usually use a set up with three arms on one side and one arm on the other. Because the hemicolectomy requires a large surgical field, working on both the left and right, a two-arm set up on each side was used. 

The nephrectomy involved a large tumor with a great deal of inflammation around it, however, the procedure was completed smoothly with little blood loss. The patient was then moved into a supine position and one of the Hugo™ RAS arm carts was moved to the other side of the patient for the hemicolectomy. Only one additional trocar was needed.

Professor Rotolli explained that, “Because Hugo™ RAS has individual arm carts, we were able to start with the nephrectomy with three carts on the left side and one cart on the right, using the access ports we drew together – then we moved one cart to the right side for the two-plus-two setup needed for the hemicolectomy. It took only a few minutes.” 

The surgeons reported that the operation went smoothly as planned. Both were pleased with the efficiency the Hugo™ RAS system facilitated in transitioning from one procedure to the next. 

Teamwork was key

To perform an operation as complex as this, the surgeons concurred it was essential to work closely as a team in pre-surgical planning, as well as during the procedure itself. Fortunately, a collaborative relationship already existed between hospital specialties at Sant’Orsola Hospital. 

“We do advanced oncologic surgery in our hospital. So, at least once a week, we carry out big oncologic operations for cancers with a lot of colleagues – urologists, vascular surgeons, orthopedics – so we know how they work,” shared Professor Rotolli. 

In the OR, the flexibility of the Hugo™ RAS system helped enable the teamwork required for this procedure. Additionally, because the Hugo™ RAS system has an open console, both surgeons were able to have simultaneous 3D vision, which aided their collaboration.

A dedicated partner

Throughout their journey with implementation of the Hugo™ RAS system, the Sant’ Orsola team has relied on close collaboration with Medtronic.

"I knew Medtronic because we use a lot of their instruments – and I know that they really care about the customer and patients, about the quality. I have to say, I saw a step up and evolution of this kind of relationship when we started doing robotic surgery with the Hugo™ RAS system. There is a team of startup specialists who work with us every day. And everyone is so committed to this project."

- Prof. Matteo Rotolli

When it came time to perform a complex procedure such as this combined nephrectomy and hemicolectomy, the Medtronic team supported the process through planning and on-site collaboration during the procedure. 

A successful outcome

Postoperatively, the patient demonstrated a lot of energy. In fact, he wanted to walk around the day of the surgery. The patient started eating after one day and was released to go home after five days. The patient now reports being able to return to his pre-surgical activity level. 

Professor Rotolli extols, “That's the real success here.”  

Hear more from Prof. Rottoli and Prof. Schiavina

The surgical setup referenced in this publication was not evaluated or tested by Medtronic. Please note that if using this setup, the device may not reach all regions of the intended surgical field, resulting in decreased workspace at the bedside and/or increased arm collisions. These situations may lead to procedure delay and/or harm to patient or user.

The Medtronic Hugo™ RAS system is commercially available in certain geographies. Regulatory requirements of individual countries and regions will determine approval, clearance, or market availability. In the EU, the Hugo™ RAS system is CE marked. In the U.S., the Hugo™ system is an investigational device not for sale.

The demonstration of safety and effectiveness for the specific procedures discussed was based on evaluation of the device as a surgical tool that assists in the accurate control of robotically-controlled instruments to perform coordinated surgical tasks. The evaluation did not include assessment of outcomes related to the treatment of cancer (e.g., overall survival, disease-free survival, local recurrence) or any specific treatment of any underlying disease or condition.