Robot-assisted Surgery Research Articles

Paranoid About Androids: A Review of Robotics in Radiology.

In tandem with the ever-increasing global population, the demand for diagnostic radiology service provision is on the rise and at a disproportionate rate compared to the number of radiologists available to practice. The current "revolution in robotics" promises to alleviate personnel shortages in many sectors of industry, including medicine. Despite negative depictions of robots in popular culture, their multiple potential benefits cannot be overlooked, in particular when it comes to health service provision. The type of robots used for interventional procedures are largely robotic-assistance devices, such as the Da Vinci surgical robot. Advances have also been made with regards to robots for image-guided percutaneous needle placement, which have demonstrated superior accuracy compared to manual methods. It is likely that artificial intelligence will come to play a key role in the field of robotics and will result in an increase in the levels of robotic autonomy attainable. However, this concept is not without ethical and legal considerations, most notably who is responsible should an error occur; the physician, the robot manufacturer, software engineers, or the robot itself? Efforts have been made to legislate in order to protect against the potentially harmful effects of unexplainable "black-box" decision outputs of artificial intelligence systems. In order to be accepted by patients, studies have shown that the perceived level of trustworthiness and predictability of robots is crucial. Ultimately, effective, widespread implementation of medical robotic systems will be contingent on developers remaining cognizant of factors that increase human acceptance, as well as ensuring compliance with regulations.

Angle Sensor for Minimally Invasive Surgical Robot Based on Surface Plasmon Resonance with Kretschmann Prisms

Angle Sensor for Minimally Invasive Surgical Robot Based on Surface Plasmon Resonance with Kretschmann Prisms

Robotic-Assisted Lymphedema Surgery: Bridging the Gap in Training and Expanding Complex Surgical Options.

The prevalence of lymphedema is likely to rise substantially in the coming decades, given projected increases in cancer. Lymphedema surgeries can improve patients' quality of life, but the shortage of surgeons capable of performing these surgeries may be a barrier to treatment. Robotic platforms may elevate novice and less-seasoned surgeons' skills, expediting their ability to perform lymphovenous anastomoses. At the same time, robotic systems may ameliorate work-related musculoskeletal stresses, which could extend the careers of microsurgeons. Moreover, as research progresses into novel applications, the integration of advanced robotic technology may become crucial. Continued exploration of these emerging fields will not only expand the possibilities for treatment but also necessitate further advancements in surgical techniques and training methodologies. The ongoing development and implementation of robotic systems like Symani could thus be instrumental in addressing the growing global burden of lymphedema and other complex surgical challenges.

Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single center experience

PurposeThe aim of the study was to compare the perioperative outcomes of patients affected by inflammatory bowel disease (IBD) who underwent surgery performed through laparoscopy or using the Medtronic Hugo™ RAS.MethodsThis is a retrospective study from a prospectively maintained database comparing laparoscopic vs. robotic-assisted surgery for IBD from 01/11/2017 to 15/04/2024. All procedures were performed by a single surgeon robotic-naïve with a large experience in laparoscopic surgery for IBD. The robotic procedures were performed using the Medtronic Hugo™ RAS platform. Outcomes were 30-day postoperative complications, operative time, conversion rate, intraoperative complications, length of hospital stay, and readmission rate.ResultsAmong 121 consecutive patients, 80 underwent laparoscopic (LG) and 41 robotic-assisted surgery (RG). Baseline, preoperative and disease-specific characteristics were comparable except for older age (50 [38–56] vs. 38 [28–54] years; p = 0.05) and higher albumin level (42 [40–44] vs. 40 [38–42] g/L, p = 0.006) in the RG. The intracorporeal anastomosis was more frequent in the RG (80% vs. 6%; p < 0.001) with longer operative time (240 vs. 205 min; p = 0.006), while the conversion rate was not different (5% vs. 10%, p = 0.49). Surgical procedure types were equally distributed between the two groups, and the rate of intra-abdominal septic complication (IASC) was comparable across the different procedures. Postoperative complications were similar, including the rate of IASC (5% vs. 5%, p = 1), postoperative ileus (5% vs. 7.5%, p = 0.71), bleeding (2% vs. 5%, p = 0.66), and Clavien-Dindo > 2 complications (7% vs. 6%; p = 1).ConclusionIBD surgery performed using the Medtronic Hugo™ RAS is safe and feasible, with similar postoperative outcomes when compared to the laparoscopic approach.

Robotic assisted simple prostatectomy mitigates perioperative morbidity compared to open simple prostatectomy - a single institution report

BackgroundAccording to the guidelines of the European Association of Urology, open simple prostatectomy should be offered to men with a prostate size exceeding 80 mL suffering from moderate to severe LUTS in the absence of a transurethral enucleation technique. However, open simple prostatectomy is associated with complications such as bleeding, blood transfusions and increased length of stay compared to minimally invasive procedures. The aim of the study was to compare perioperative data from the first cases of robotic assisted simple prostatectomy (RASP) to that of patients subjected to open simple prostatectomy (OSP) at our department.MethodsThe patients were identified by a search for the respective procedure codes. In the OSP group enucleation of the adenoma was performed through the prostatic capsule (Millin procedure), while access to the adenoma was gained through the bladder in the RASP group. Complications were scored according to the Clavien-Dindo classification system.Results27 patients who underwent OSP were retrospectively identified and compared to the first 26 patients who were subjected to RASP. The groups were similar with respect to age, body mass index and ASA score. Operative time was significantly shorter in the OSP group compared to the RASP group. Bleeding volume, drop in postoperative hemoglobin and the number of blood transfusions were all significantly higher in the OSP group compared to the RASP group. Average length of stay was 5.5 (2–18) days in the OSP group compared to 1.6 (1–5) days in the RASP group (p < 0.001). The number of postoperative complications, Clavien-Dindo ≥ 2, were significantly higher in the OSP group (11) compared to the RASP group (none, p < 0.001).ConclusionsThe introduction of robotic assisted simple prostatectomy reduced perioperative morbidity at our department.

Primary vesicoureteral reflux.

Primary vesicoureteral reflux (VUR) is one of the most common urological abnormalities in infants and children. The association of VUR, urinary tract infection (UTI) and renal parenchymal damage is well established. The most serious complications of VUR-associated reflux nephropathy are hypertension and proteinuria with chronic kidney disease. Over the past two decades, our understanding of the natural history of VUR has improved, which has helped to identify patients at increased risk of both VUR and VUR-associated renal injury. The main goals in the treatment of paediatric patients with VUR are the prevention of recurrent UTIs and minimizing the risk of renal scarring and long-term renal impairment. Currently, there are four options for managing primary VUR in infants and children: surveillance or intermittent treatment of UTIs with management of bladder and bowel dysfunction; continuous antibiotic prophylaxis; endoscopic subureteral injection of tissue-augmenting substances; and ureteral reimplantation via open, laparoscopic or robotic-assisted surgery. Current debates regarding key aspects of management include when to perform diagnostic imaging and how to best identify the paediatric patients that will benefit from continuous antibiotic prophylaxis or surgical intervention, including endoscopic injection therapy and minimally invasive ureteral reimplantation. Evolving technologies, such as artificial intelligence, have the potential to assist clinicians in the decision-making process and in the individualization of diagnostic imaging and treatment of infants and children with VUR in the future.

Clinical usability and efficacy of a robotic bone fracture reduction system: A pilot animal study

Challenges in minimally invasive surgeries, such as intramedullary nailing for long bone fractures, include radiation overexposure for patients and surgeons, potential malreduction, and physical burden on surgeons in maintaining the reduction status. A robotic bone fracture reduction system was developed in this study to address these problems. The system consists of a hexapod with six degrees of freedom, with a fracture reduction device and a master device. This study aimed to evaluate the novel system in a preclinical setting. The length of the six axes in the system can be adjusted to precisely control the length, angle, and rotation so that no additional traction is required. Fluoroscopic images can be remotely examined to reduce the risk of radiation exposure for surgeons. In this study, alignment accuracy and radiation exposure were measured using 32 bovine bone fracture models, and these surgical outcomes were compared to those of conventional manual surgery to verify the clinical usability and effectiveness of the system. The alignment accuracy was assessed by analyzing length, angulation, and rotation. The four surgeons participating in this study were divided into two groups (expert and novice) according to their clinical experience. All parameters in robotic surgery significantly decreased by approximately 4 mm and 8° on average (p ≤ 0.05) compared to conventional surgery. The mean radiation exposure in robot-assisted surgery was 0.11 mSv, showing a significant decrease compared to conventional surgery (p < 0.05). Reduction accuracy was higher in robotic surgery performed by the novice group than in conventional surgery performed by the expert group; however, standard deviation values were inversed. In conclusion, the bone fracture reduction robot system increased the alignment accuracy through precise control while reducing radiation exposure in surgeons, as the surgery was performed remotely. The use of this system is predicted to improve the accuracy and reproducibility of the surgery and the safety of medical staff.11Abbreviations: CT, computed tomography; FRD, fracture reduction device; FRMD, fracture reduction master device; SD, standard deviation

Current Status and Prospects of Robotic-Assisted Thoracoscopic Surgery

Current Status and Prospects of Robotic-Assisted Thoracoscopic Surgery

Transoral Laser or Robotic Surgery Outcomes for Oropharyngeal Carcinoma

Transoral robotic surgery (TORS) or transoral laser microsurgery (TLM) offer excellent oncological outcomes for oropharyngeal squamous cell carcinoma caused by human papillomavirus (HPV) infection. TORS may offer greater margin clearance around tumors than TLM. To determine whether the differing energy sources used and surgical technique of TORS or TLM is associated with postoperative early swallowing function, feeding tube use, and specific factors related to quality of life. This prespecified cohort study was performed within the Postoperative Adjuvant Treatment for HPV-Positive Tumours (PATHOS) randomized clinical trial at 40 centers in the UK, Germany, France, the US, and Australia between November 1, 2015, and August 31, 2023. PATHOS trial participants with HPV-positive oropharyngeal carcinoma of stages T1 to T3 and N0 to N2b M0 (TNM7) who underwent TLM or TORS were eligible. Of 989 consecutively recruited patients on the PATHOS trial, 508 were eligible for this substudy. The exposure of interest was TORS or TLM. Preplanned outcome measures included nasogastric tube insertion rates within 4 weeks after surgery, length of in-hospital stay following surgery, specific scales from the MD Anderson Dysphagia Inventory (MDADI), 35-item European Organization for Research and Treatment of Cancer Head and Neck Questionnaire (H&N35), and 30-item Quality of Life Questionnaire (QLQ C30), water swallow test results, and videofluoroscopy scores. Of the 508 patients included in the analysis (390 [76.8%] male; median age, 58.3 [IQR, 52.8-63.6] years), 195 had TLM and 313 had TORS. Nasogastric tube insertion rates were higher after TORS than TLM (85 of 189 [45.0%] vs 10 of 126 [7.9%]; adjusted odds ratio [OR], 4.41 [95% CI, 1.01-19.32]). Mean scores favored TLM with small effect sizes in all MDADI domains and the H&N35 swallowing item at 4 weeks after surgery; between-group difference for the MDADI composite score was -4.89 (95% CI, -8.27 to -1.50); for the MDADI physical functioning score, -6.37 (95% CI, -10.15 to -2.59); for the MDADI global score, -10.02 (95% CI, -16.50 to -3.54); and for H&N35 swallowing score, 7.24 (95% CI, 2.17-12.30). No other measures showed evidence of clinically meaningful differences. In this cohort study, functional outcomes were moderately less impaired 4 weeks following TLM compared with TORS. Once the longer-term outcomes for these patients are known, these findings could aid the design and use of future head and neck-specific surgical robots. ClinicalTrials.gov Identifier: NCT02215265.

A novel anterior approach toward robotic radical prostatectomy is associated with earlier continence recovery than the conventional approach.

To advance robotic radical prostatectomy, we developed a novel anterior approach that uses a peritoneal incision created between the umbilical ligaments to develop the Retzius space and thus spares vessels that surround the bladder and prostate, with the space being closed after prostatectomy and vesicourethral anastomosis. This approach may improve continence recovery. We investigated continence recovery following the novel anterior approach compared to after the conventional anterior approach. We retrospectively reviewed 516 patients who underwent robotic radical prostatectomy from January 2019 to July 2023. We compared continence recovery following our novel anterior approach (N = 282) to that after conventional anterior approach (N = 234), and we compared the oncological outcomes and safety profiles of the two groups. Patient demographics did not differ significantly between the two groups. Continence recovery in patients undergoing the novel anterior approach was significantly better than that of patients treated via the conventional approach (hazard ratio: 1.651, 95% confidence interval: 1.325-2.057, p < 0.0001). Use of the novel anterior approach in addition to nerve sparing and preservation of the detrusor apron independently predicted continence, and the mixture of these three techniques afforded excellent continence recovery (1- and 2-year total continence rate of 81.1% and 93.7%). Neither the biochemical recurrence-free survival nor the complication rate differed significantly between the two groups. Our novel anterior approach may improve continence recovery compared to the conventional anterior approach, without compromising the oncological outcomes. Prospective comparative studies are necessary to confirm the benefits of this approach.

HoLLiECares - Development of a multi-functional robot for professional care.

Germany's healthcare sector suffers from a shortage of nursing staff, and robotic solutions are being explored as a means to provide quality care. While many robotic systems have already been established in various medical fields (e.g., surgical robots, logistics robots), there are only a few very specialized robotic applications in the care sector. In this work, a multi-functional robot is applied in a hospital, capable of performing activities in the areas of transport and logistics, interactive assistance, and documentation. The service robot platform HoLLiE was further developed, with a focus on implementing innovative solutions for handling non-rigid objects, motion planning for non-holonomic motions with a wheelchair, accompanying and providing haptic support to patients, optical recognition and control of movement exercises, and automated speech recognition. Furthermore, the potential of a robot platform in a nursing context was evaluated by field tests in two hospitals. The results show that a robot can take over or support certain tasks. However, it was noted that robotic tasks should be carefully selected, as robots are not able to provide empathy and affection that are often required in nursing. The remaining challenges still exist in the implementation and interaction of multi-functional capabilities, ensuring ease of use for a complex robotic system, grasping highly heterogeneous objects, and fulfilling formal and infrastructural requirements in healthcare (e.g., safety, security, and data protection).

Current status and future of application of spinal surgery robot in spinal deformity surgery

At present, spinal surgical robots can be used for preoperative surgical planning, pedicle screw placement, and intervertebral processing and intervertebral fusion in spinal deformity surgery. Existing spinal surgical robots have become the main means for spinal surgery to improve surgical accuracy and safety and reduce surgical complications. However, the efficiency of robot-assisted spinal deformity surgery is lower than that of traditional surgery, and there are shortcomings such as low accuracy of robot screw placement and fewer integrated functions. This article reviews the current application status and future development trends of spinal surgical robots in spinal deformity surgery.

Outcomes of Patients With Early and Locally Advanced Lung Cancer: Protocol for the Italian Lung Cancer Observational Study (LUCENT).

Lung cancer, predominantly non-small cell lung cancer (NSCLC), remains a formidable challenge, necessitating an in-depth understanding of evolving treatment paradigms. The Italian Lung Cancer Observational Study (LUCENT) addresses this need by investigating the outcomes of patients with early and locally advanced lung cancer in Italy. With a focus on real-world data and patient registries, this study aims to provide comprehensive insights into clinical, psychosocial, and economic impacts, contributing to informed decision-making in health care. LUCENT is a prospective observational multicenter cohort study enrolling patients eligible for minimally invasive manual, robot-assisted, or traditional open surgery. The study will develop a web-based registry to collect longitudinal surgical, oncological, and socioeconomic outcome data. The primary objectives include performance assessment through the establishment of national benchmarks based on risk-adjusted outcomes and processes of care indicators. The secondary objectives encompass economic and psychosocial impact assessments of innovative technologies and treatment pathways. The multicenter design ensures a diverse and representative study population. The evolving landscape of NSCLC treatment necessitates a nuanced approach with consideration of the dynamic shifts in therapeutic strategies. LUCENT strives to fill existing knowledge gaps by providing a platform for collecting and analyzing real-world data, emphasizing the importance of patient-reported outcomes in enhancing the understanding of the disease. By developing a web-based registry, the study not only facilitates efficient data collection but also addresses the limitations of traditional methods, such as suboptimal response rates and costs associated with paper-and-pencil questionnaires. Recruitment will be conducted from January 01, 2024, to December 31, 2026. Follow-up will be performed for a minimum of 2 years. The study will be completed in the year 2028. LUCENT's potential implications are substantial. Establishing national benchmarks will enable a thorough evaluation of outcomes and care processes, guiding clinicians and policymakers in optimizing patient management. Furthermore, the study's secondary objectives, focusing on economic and psychosocial impacts, align with the contemporary emphasis on holistic cancer care. Insights gained from this study may influence treatment strategies, resource utilization, and patient well-being, thereby contributing to the ongoing refinement of lung cancer management. ClinicalTrials.gov NCT05851755; https://clinicaltrials.gov/study/NCT05851755. ISRCTN 67197140; https://www.isrctn.com/ISRCTN67197140. PRR1-10.2196/57183.

Comparison of the effectiveness of open, laparoscopic, and robotic-assisted radical prostatectomies based on complication rates: a retrospective observational study with administrative data from Switzerland

BackgroundRadical prostatectomies can be performed using open retropubic, laparoscopic, or robot-assisted laparoscopic surgery. The literature shows that short-term outcomes (in particular, inpatient complications) differ depending on the type of procedure. To date, these differences have only been examined and confirmed in isolated cases based on national routine data.MethodsThe data was based on the Swiss Medical Statistics from 2016 to 2018 from a national survey of administrative data from all Swiss hospitals. Cases with the coded main diseases neoplasm of the prostate (ICD C61) and the main treatments of laparoscopic (CHOP 60.5X.20) or retropubic (CHOP 60.5X.30) radical prostatectomies were included, resulting in a total sample size of 8,593 cases.ResultsA procedure-related complication occurred in 998 cases (11.6%). By surgical procedure, complication rates were 10.1% for robotic-assisted laparoscopic radical prostatectomy 9.0% for conventional laparoscopic radical prostatectomy and 17.1% for open retropubic radical prostatectomy (p < 0.001). Conventional and robotic-assisted laparoscopic radical prostatectomies had a significantly lower risk of complications than retropubic procedures. Moreover, the risk of a procedure-related complication was almost twice as high in cases operated on retropubically; however, no significant difference was found between conventional and robotic-assisted laparoscopic cases.DiscussionThe use of a surgical robot showed no advantages in radical prostatectomies regarding procedure-related during the hospital stay. However, both conventional and robotic-assisted laparoscopically operated radical prostatectomies show better results than open retropubic procedures. Further studies on the long-term course of patients based on claims data are needed to confirm the inherent benefits of surgical robots in tandem with them being increasingly employed in hospitals.

Next-Gen Surgery: AI Robots Leading the Way in Healthcare

As human generations evolve, medical science and engineering have developed, and robotics have become an integral part of medicine from administrative duties to surgical procedures. In medical procedures, robotic systems support and enhance the accuracy and agility of human surgeons. This method is known as robotic surgery or robotic-assisted surgery (RAS). In the public health field, RAS plays an essential role due to its ability to improve surgical precision, lessen patient discomfort following surgery, and shorten hospital stays. In spite of the systems not being entirely self-contained, skilled surgeons use a console and specialized instruments to perform procedures that are more accurate and less invasive. Robots can help provide healthcare services such as monitoring vital signs, administering medications, and providing emotional support. The use of AI with robotics in healthcare has shown a remarkable rise in the past few years, particularly in rural India with limited access to healthcare providers and limited health resources. Urban and rural hospitals across the country can use artificial intelligence to manage tasks like surgery assistance, streamlining hospital logistics, and organizing routine checkups. The following considerations are the main causes of a surge in robotic help in the healthcare sector: (a) robots are hardworking; (b) they can withstand stress; (c) their grasping abilities; (d) they can do precise surgeries; and (e) they are capable of performing repetitive jobs. The present discourse delves into a few medical robotics applications, discussing their advantages, disadvantages, and possible avenues for future research and development.

Customizing Surgical Robots for Specialty Surgeries

Customizing Surgical Robots for Specialty Surgeries

Impact of landmark crater creation on improving accuracy of pedicle screw insertion in robot-assisted scoliosis surgery.

This study evaluated the impact of the Landmark Crater (LC) method on pedicle perforation rates in robot-guided surgery for pediatric scoliosis for each pedicle diameter. Seventy-six scoliosis patients underwent robot-assisted posterior spinal fusion. The cohort consisted of 19 male and 57 female patients, with a mean ± standard deviation age of 17.5 ± 7.7 years and a preoperative Cobb angle of 57.0 ± 18.5°. The LC method is a method in which craters that serves as a landmark are created in advance at the planned PS insertion site of all pedicles within the intraoperative CT imaging area. The patients were divided into the LC group, in which PS insertion was performed using the LC method, and the control group using the conventional PS insertion method. Overall and pedicle perforation rates for each pedicle outer diameter were compared between the groups by Fisher's exact test. The LC group exhibited a significantly lower pedicle major perforation rate than did the control group (2.7% vs. 6.2%, P = 0.001). The perforation rates in pedicles with a pedicle outer diameter > 6mm, 4-6mm, 2-4mm, and < 2mm were 0.61%, 1.6%, 5.1%, and 21%, in the LC group and 0.75%, 4.1%, 12%, and 50% in the control group, respectively. In robot-assisted surgery for pediatric scoliosis, the LC method enabled significantly lower pedicle perforation rates over the conventional method. Both the LC and conventional methods exhibited higher perforation rates for smaller pedicle diameters.

Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach. These limitations include a relatively large fascial incision length, potentially increasing rates of postoperative pain, abdominal bulge, hernia rates, and core weakening. The robotic-assisted DIEP flap technique emerges as an innovative and advantageous approach in fascial-sparing abdominal autologous breast reconstruction. While acknowledging certain challenges such as increased operative time, ongoing refinements are expected to further improve the overall surgical experience, optimize results, and solidify the role of robotics in advancing reconstructive microsurgical procedures in plastic surgery. Herein, the authors provide an overview of robotic surgery in the context of plastic surgery and its role in the DIEP flap harvest for breast reconstruction.

Rethinking Surgical Safety: Investigating the Impact of Gamified Training on Severe Flow Disruptions in Surgery.

There is a need for effective and engaging training methods to enhance technical and nontechnical skills in robotic-assisted surgery (RAS), where deficiencies can compromise safety and efficiency. This study aims to evaluate the impact of a gamified team training intervention, the "RAS Olympics," on the safety and efficiency of RAS procedures. The study was conducted at a 958-bed tertiary care academic medical center in with a robust robotic surgery program. A total of 56 RAS procedures (general, urology, and gynecology) were included in the analysis, with a mix of procedure types representative of the surgical caseload at the medical center. A pretest posttest experimental design was employed, comparing the frequency and severity of flow disruptions (FD) between preintervention, postintervention without "RAS Olympics" participants, and postintervention with "RAS Olympics" participants. The "RAS Olympics" involved safety hazard identification, troubleshooting, workspace navigation, instrument retrieval, and turnover optimization. Postintervention cases with "RAS Olympics" participants exhibited significantly lower overall FDs compared to the postintervention control group. The reduction was particularly notable during phase 3 (surgeon on console) and in cases involving more severe FDs. Gamified team training interventions may improve the safety and efficiency of RAS procedures. The positive outcomes underscore the potential of innovative and engaging training methods to address the evolving challenges in surgical practice, emphasizing the relevance of gamification in healthcare education. As the healthcare landscape continues to advance, incorporating such interventions may be crucial in ensuring the adaptability and competence of surgical teams.

Extraperitoneal Robot-Assisted Radical Prostatectomy with the Hugo™ RAS System: Initial Experience at a High-Volume Robotic Centre.

Background: The Hugo™ Robotic-Assisted Surgery (Hugo™ RAS) system represents a novel advancement in robotic surgical technology. Despite this, there remains a scarcity of data regarding extraperitoneal robot-assisted radical prostatectomy (eRARP) using this system. Methods: We conducted a prospective study at Ospedale Regionale "F. Miulli" from June 2023 to January 2024, enrolling consecutive patients diagnosed with prostate cancer (PCa) undergoing eRARP ± lymph node dissection. All procedures employed a modular four-arm setup performed by two young surgeons with limited prior robotic surgery experience. This study aims to evaluate the safety and feasibility of eRARP using the Hugo™ RAS system, reporting comprehensive preoperative, intraoperative, and postoperative outcomes in the largest reported cohort to date. Results: A total of 50 cases were analyzed, with a mean patient age of 65.76 (±5.57) years. The median operative time was 275 min (Q1-Q3 150-345), and the console time was 240 min (Q1-Q3 150-300). The docking time averaged 10 min (Q1-Q3 6-20). There were no intraoperative complications recorded. Two major complications occurred within the first 90 days. At the 3-month mark, 36 patients (72%) achieved undetectable PSA levels (<0.1 ng/mL). Social continence was achieved by 66% of patients, while 40% maintained erectile function. Conclusions: eRARP utilizing the Hugo™ RAS system demonstrated effectiveness and safety in our study cohort. However, more extensive studies with larger cohorts and longer follow-up periods are necessary to thoroughly evaluate long-term outcomes.