Sacrocolpopexy is a standard surgical procedure for pelvic organ prolapse (POP) repair, offering anatomical correction. In Japan, robotic-assisted sacrocolpopexy (RASC) was approved for insurance coverage in April 2020 and has since become widely adopted. Our department has performed RASC using various robotic systems, including the da Vinci (S, Xi, SP) and hinotori since 2013. In November 2024, we introduced the Hugo RAS system for RASC, and we report our initial experience.

We retrospectively analyzed 3 cases of POP treated with RASC using the Hugo RAS system between November 2024 and February 2025. The median age was 71 years (range: 69-73 years), and the median BMI was 26.0 (range: 21.4-26.3). All patients had stage 4 POP-Q. One patient had a history of open abdominal surgery for ectopic pregnancy. The median follow-up period was 2.4 months (range: 0.8-3.6 months).

The median operative time was 263 minutes (range: 255-273 minutes), and the median console time was 187 minutes (range: 163-210 minutes). The median blood loss was 10 g (range: 4-16 g). No intraoperative or postoperative complications, de novo stress urinary incontinence (SUI), or POP recurrence were observed in any case.

The Hugo RAS system offers flexible arm positioning, allowing for tailored adjustments based on individual patient anatomy. Additionally, its open console system facilitates enhanced communication among the surgical team, as multiple staff members can view the operative screen simultaneously. Our initial experience demonstrated that RASC using the Hugo RAS system was comparable in efficacy and safety to conventional robotic platforms. Further studies with larger sample sizes and longer follow-up periods are necessary to validate these findings.