Policlinico Gemelli IRCCS di Roma

In the operating room with the robot Hugo at Gemelli University Hospital Foundation

Friday, March 11, 2022

Original article: https://www.policlinicogemelli.it/news-eventi/al-gemelli-in-sala-operatoria-con-il-robot-hugo/

For the first time in Europe, at the Agostino Gemelli IRCCS University Hospital Foundation in Rome, a gynecological surgery was performed with Hugo, the new robot-assisted surgical system (RAS) developed by Medtronic, a leading company in HealthCare Technology. Professor Giovanni Scambia, Director of the University Department of Life Sciences and Public Health of the Catholic University and Scientific Director of the Polyclinic Foundation, carried out this first hystero-adnexectomy (removal of uterus and ovaries) on a 62-year-old woman.

prof. Giovanni Scambia
prof. Giovanni Scambia

"The one carried out today at the Gemelli Polyclinic Foundation - explains Professor Scambia - is the first gynecological surgery carried out in Europe with the new Hugo robot-assisted surgery system, a new robotic platform which, in addition to being the result of advanced and innovative technologies, has very competitive costs compared to the previous robotics. And this could finally launches this branch of surgery, born twenty years ago and still used in just 3% of all surgeries performed every year in the world. Having this new equipment available makes the Gemelli Polyclinic even more avant-garde at an international level. We plan to use the new Hugo robot-assisted surgery system, not only for benign gynecological pathologies of increasing complexity, but also for oncological pathology, gradually performing ever more complex and minimally invasive interventions ".

The 'historic' intervention

Lasting almost one hour, the first gynecological surgery performed in Europe with the Hugo robot-assisted surgery system is a prophylactic hysteroexectomy on a 62-year-old patient with a BRCA mutation (the so-called Angelina Jolie gene), which exposes at an increased risk of gynecological malignancies. The different phases of the intervention are the same used also in the case of an intervention of this type performed by the team of Professor Scambia in laparotomy or laparoscopy. It is therefore not the operating technique that adapts to the robot, but vice versa. The first step (starting on the left) is the resection of the round ligament of the uterus, which allows access to the retroperitoneal organs, in particular the ureter, to secure it. The uterine artery is then identified and closed with a surgical clip at its origin; then the influndibulum-pelvic ligament (which contains the vessels directed to the ovary) is identified and isolated from the ureter, then coagulated and sectioned. The operator then starts to work in the anterior compartment, where he detaches the vesico-uterine septum, to make the bladder slide down, away from the uterus; then they coagulate and dissect the uterine vein and artery at the level of the body of the uterus. These same operations are repeated on the right side. At this point, the uterus is isolated from all its 'hooks'. A circular incision is then made on the vagina with electrified scissors, right below the cervix; at this point the uterus, ovaries and tubes are extracted through the vagina. The surgery is completed by making a continuous stitch suture of the vaginal stump. (comment by Dr. Nicolò Bizzarri)

A new era in robotic surgery

The Hugo robot-assisted surgery system was created to make the benefits of robotic surgery available to more patients around the world, both in the gynecological and urological fields, which today represent about half of the interventions with robotic technology performed. This can happen thanks to the more sustainable costs and greater flexibility (it is a 'module' system that is well suited to all types of operations and operating rooms) this technology provides. In short: it is a 'democratic' robotic surgery system.

"The indissoluble link between technological evolution and clinical excellence - comments Engineer Giovanni Arcuri, Technical Department and Health Technology Innovation Department, Agostino Gemelli IRCCS University Hospital Foundation - represents the only possible way to guarantee patients state-of-the-art care. For this reason, the Gemelli Polyclinic continues to invest in technological solutions, with which our specialists can make treatment processes evolve, offering increasingly minimally invasive and effective surgical interventions. The Hugo robot-assisted surgery system is an innovative and technologically very advanced platform that is set to become a reference for the surgery of the future, also thanks to operating costs that make its adoption sustainable. Our goal as a Polyclinic is to combine clinical and technological excellence with economic sustainability, in the awareness that innovation represents an added value, only when it makes the benefits accessible to all patients. "

To robotic surgery school

Another advantage of the Hugo RAS system is that it has a fast training learning curve. Medtronic also takes care of training, which consists on a theoretical-practical course in the presence, in specialized environments, such as the Orsi Academy in Ghent (Belgium). After the theoretical-practical course, surgeons experienced in the use of the Hugo robot-assisted surgery system (so-called proctors) work alongside the 'trainee' surgeons in the execution of the first operations as supervisors in the operating room. The Gemelli Polyclinic Foundation will in the future make an important contribution to clinical development, training of new surgeons, and the progressive expansion of the type and number of operations in which to use it. The Gemelli thus joins a group of pioneering institutions, among the first in Europe to participate in Medtronic's "Partners in Possibility" program and among the first in the world to use the Hugo RAS system and to contribute to the global patient registry.

A work of art to commemorate this historic moment

Professor Giovanni Scambia asked Maestro Giovenale to interpret this historic moment in the field of robotic surgery through his artistic sensitivity. "La Luce dell'anima" is a piece of art that is part of a special path desired by Professor Scambia to narrate all the themes of research about women's health with the language of art. “Patients - explains Professor Scambia - have two fears regarding robotic surgery; the first is that it is the robot and not the surgeon who operates; the second is in general on the use of technologies in medicine, when they replace the hand of man. This picture precisely means that whoever works through the robot is always the surgeon's hand, guided, according to our sensitivity as Catholics, by the hand of God. In the picture there is also a stylized guardian angel and a series of luminous holes, which help us to see beyond, the invisible".

In 2021, Medtronic's Hugo RAS system received the CE (Conformité Européenne) mark, which authorized its sale in the European Union, for urological and gynecological interventions, while other indications will be confirmed shortly.

"The arrival of Medtronic's Hugo robot-assisted surgery system - says Michele Perrino, President and CEO of Medtronic Italy - marks a new era of robotic surgery, which makes healthcare technology more accessible, overcoming the barriers related to the cost that have held back its adoption. Leading-edge also in vertebral surgery, thanks to the Mazor ™ robotic platform already available on the market, for Medtronic, innovation, the use of technology and data analysis, which are the characteristics that distinguish also the robotic surgery system assisted Hugo, are key drivers for improving health outcomes and extending access to care by democratizing surgery. The adoption of the Hugo robot-assisted surgery system in a center of excellence such as the Gemelli University Hospital Foundation confirms our willingness to collaborate with Institutes that share our vision, taking another significant step to make minimally invasive robotic surgery accessible to more patients and health facilities in the world, thus contributing to a real transformation of the health system in which innovation and technology play a fundamental role ".

Gemelli Rome Triangle


Gemelli Rome Triangle