Optimizing arm placement in the Hugo™ RAS system-based hysterectomy: development and validation of a simplified "Narrow setting" approach.

We aimed to determine the usefulness of the new setup, the "Narrow setting," by examining our initial experience with the Hugo^™ RAS system. 78 hysterectomies using the Hugo^™ RAS system performed in "Narrow setting" at our institution from November 2023 to December 2024 were included in this study. We retrospectively examined the patient's clinical information and surgical outcomes from the medical record. We also investigated the learning curve of docking time in this setting by cumulative summation analysis. The median age, body mass index, and uterine weight of the patients were 48 (31-76) years, 22.9 kg/m² (16.1-42.4), and 178 g (40-2000 g), respectively. More than half of the surgical indications were uterine myomas (52.6%, 41/78). The median operative, console, and docking times were 68 min (48-198 min), 46 min (29-151 min), and 9 min (6-31 min), respectively. The median estimated blood loss was 5 mL (5-220 mL). A total of eight perioperative complications were observed, but only one was classified as Clavien-Dindo grade III or higher. No conversion to open or laparoscopic surgery was required. The learning curve for docking time showed that docking in the "Narrow setting" can be proficient in 19 cases. We reported on our initial experience with hysterectomy using the Hugo^™ RAS system and found the "Narrow setting" to be safe and efficient.