Robotic-Assisted Retromuscular Umbilical Prosthetic Hernia Repair (r-TARUP) With Hugo-RAS System: Case Series and Technique

BACKGROUND: Minimally invasive approaches have transformed ventral hernia management, with robotic platforms enhancing challenging techniques like the robotic Transabdominal Retromuscular Umbilical Prosthesis (r-TARUP). While traditionally performed using the da Vinci system, the introduction of the Medtronic Hugo RAS system offers a valuable alternative. We present our first case series with standardized surgical technique for r-TARUP using the Hugo RAS system, detailing operative setup, technical considerations, and initial outcomes. METHODS: Between September 2024 and February 2025, we performed 30 r-TARUP procedures using the Hugo RAS system. Preoperative evaluation included imaging and risk factor optimization. The technique involved a lateral retromuscular approach, ipsilateral posterior rectus sheath (PRS) closure, and mesh placement. Patients were discharged the following day, with follow-ups assessing complications and recurrences. RESULTS: The mean hernia dimensions were 3.1±1.0 cm in width and 2.6±0.8 cm in length. Rectus diastasis repair was performed in 57% of cases. Mean operating and docking times were 190.6±61.6 and 15±5.3 minutes, respectively. Two cases required conversion to laparoscopic surgery during peritoneal closure. No complications or recurrences were observed after a mean follow-up of 3.6 (1.7 to 5.3) months. CONCLUSIONS: Despite the short follow-up, our experience demonstrates the feasibility and safety of r-TARUP with the Hugo RAS system. Comparable outcomes to other robotic platforms suggest that the Hugo RAS system is a viable alternative for ventral hernia repair, offering technical flexibility and promising short-term results.