Propensity score matched analysis of short-term outcomes in rectal cancer robotic surgery: Hugo RAS versus da Vinci systems.

The Hugo RAS system (Hugo), comprising an open surgical console and independent arm carts was launched into the surgical robotics market following the da Vinci surgical system (da Vinci). This study was designed to disclose the feasibility of rectal surgery using Hugo vs. da Vinci systems by assessing short-term outcomes. Between September 2019 and October 2025, 211 patients underwent robotic surgery for non-metastatic rectal cancer. The outcomes of 81 Hugo-assisted and 130 da Vinci-assisted robotic surgeries were compared. The incidence of postoperative complications classified as Clavien–Dindo (CD) grade III or higher was the primary outcome. Secondary outcomes were blood loss, operative time, console time, positive circumferential resection margin (CRM), postoperative hospital stay, and mortality. Hugo and da Vinci cases were compared using 1:1 propensity score matching, balancing for age, sex, BMI, ASA-PS, tumor location, clinical T and N stage, preoperative therapy, surgeon experience, console experience and sphincter preservation. After matching, each group included 56 patients with comparable pretreatment characteristics. There were no significant differences between the Hugo and da Vinci groups in CD grade ≥ III complications (7.1% vs. 8.9%, p = 1.000), blood loss, operative time, console time, CRM positivity, postoperative hospital stay, or mortality. No open conversions occurred in either group. The Hugo system enables feasible rectal surgery with no significant differences in short-term outcomes compared with those achieved using the da Vinci system.