Medtronic's Hugo™ robotic surgery system for robot-assisted radical prostatectomy: a systematic review of current worldwide experiences

Urology's pioneering role in surgical innovations, from cystoscopy to laparoscopic surgery, culminated in the twenty-first-century advent of robotic surgery. The dominant da Vinci (R) system faced new competition following its 2019 patent expiration. Medtronic's Hugo (TM) system emerged. Its growing global adoption, especially in robot-assisted radical prostatectomy (RARP), necessitates a systematic review, evaluating safety, feasibility, and comparison with established systems. A comprehensive search identified eligible studies of the Hugo (TM) robotic platform for RARP, presenting their current experiences. Following systematic screening, quality of eligible studies was assessed using ROBINS-I. Results then underwent a narrative synthesis. This systematic review analysed 19 eligible studies, consisting of 9 comparative and 10 single arm studies. Due to the non-randomised nature of the studies, a moderate risk of bias was concluded in most. On account of the high heterogeneity between studies, a narrative synthesis of data was enacted; categorised into themes relating to operative timings, transfer of skills, patient demographics, plus safety and feasibility. Eligible studies demonstrated the promise of the Hugo (TM) platform within these themes, in comparison to currently available platforms. Despite a paucity of high-quality randomised controlled trials, available evidence indicates Hugo (TM) as a promising, safe alternative for RARP. Positive experiences across diverse centres and surgeons revealed minimal differences in surgical outcomes compared to the established da Vinci (R) system, fostering global Hugo (TM) adoption. Despite evidence demonstrating Hugo (TM) safety and comparability, the review underscores the scarcity of high-quality evidence, attributing it to early stage implementation challenges.