Robotic transabdominal preperitoneal mesh repair of an inguinal hernia using the Hugo™ Robotic Assisted Surgery system-a case report of the first Australian clinical experience in general surgery

Background: Robotic surgery has been used in a number of procedures across multiple specialities over the past two decades. The majority have been undertaken on da Vinci platforms. More recently, other robotic platforms have been introduced to the market. To date, Medtronic's HugoTM Robotic Assisted Surgery (RAS) system has been used in limited clinical settings worldwide. We performed the first general surgical procedures using HugoTM RAS in Australia. Case Description: In this case report, we present our approach to an inguinal hernia repair using HugoTM RAS for a symptomatic right indirect inguinal hernia in a 74 -year -old man. Through our accompanying video, we share the theatre setup, docking process and operative steps. We touch on some of the unique aspects of using the HugoTM RAS, technology -specific considerations and briefly contrast these to the da Vinci Xi platform. We found the use of the HugoTM RAS in performing transabdominal preperitoneal (TAPP) mesh repair of an inguinal hernia to be demonstrably feasible. Conclusions: The burden of navigating the initial experience with a new robotic platform is shouldered by early adopters who need to ensure optimal patient safety and outcomes. Here we offer our early experience for others to share. Further studies are required to demonstrate equivalence between the HugoTM RAS system and existing minimally invasive platforms in inguinal hernia repair.