Comparative perioperative outcomes of Hugo™ RAS versus laparoscopic and Da Vinci platforms for partial nephrectomy: a systematic review and meta-analysis.

Renal cell carcinoma (RCC) is a common urologic malignancy, and for localized T1 tumors, nephron-sparing surgery is now the standard of care. Laparoscopic and image-guided techniques have advanced as robotic platform procedures offer greater operator dexterity and procedural control. The da Vinci platform has dominated robot-assisted partial nephrectomy, but high costs and closed architecture limit broader use. The Hugo™ RAS system, featuring a modular design, has emerged as a promising alternative, with early studies showing feasibility and safety. However, current evidence remains preliminary, mostly single-center and small-sample. This meta-analysis aggregates data and conducts subgroup analyses to compare Hugo™ RAS with other techniques, aiming to provide more precise effect estimates and guide surgical platform selection. The four main databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were thoroughly searched to identify eligible clinical studies. The selected research involved comparative evaluations of surgical metrics of partial nephrectomy performed with Hugo™ RAS vs. the da Vinci system and traditional laparoscopy. This systematic synthesis included four observational cohort studies with a total of 383 subjects. Combined metric evaluations indicated that Hugo™ RAS demonstrated no statistically significant variation relative to alternative minimally invasive approaches regarding surgery duration (MD = 2.81 min, 95% CI [- 37.42, 43.03], p = 0.89), duration of hospitalization (MD = - 0.23 days, 95% CI [- 1.59, 1.13], p = 0.74), intraoperative blood loss (MD = 18.5 ml, 95% CI [- 53.61, 90.6], p = 0.62), serum creatinine following surgery (MD = - 0.05 mg/dl, 95% CI [- 0.18, 0.08], p = 0.44), positive surgical margin incidence (OR = 0.59, 95% CI [0.19, 1.80], p = 0.35), minor-to-moderate postoperative adverse event frequency (OR = 0.98, 95% CI [0.45, 2.17], p = 0.97), major postoperative adverse event frequency (OR = 0.74, 95% CI [0.09, 6.17], p = 0.78), overall postoperative adverse event rate (OR = 1.05, 95% CI [0.39, 2.87], p = 0.92), or successful trifecta attainment (OR = 1.11, 95% CI [0.60, 2.07], p = 0.74). This meta-analysis provided some preliminary evidence: Hugo™ RAS did not demonstrate significant differences compared to other minimally invasive surgical procedures in terms of procedure time, hospital stay, intraoperative blood loss, postoperative renal function, rate of positive margins, postoperative morbidity, and composite success results. Overall, Hugo™ RAS seems to be a reasonable surgical alternative. However, large multi-site randomized clinical trials are still needed to substantiate this finding.