Initial Clinical Experience of Robot‐Assisted Rectal Surgery by Using <scp>Hugo RAS</scp> System: Horizontal Line Port Placement With Contralateral Reserve Arm Manipulation

The benefits and advantages of robot-assisted laparoscopic surgery (RALS) over conventional laparoscopic surgery are reported in many fields. Hugo RAS system is one of the newest surgical robots; it features a modular-type robot with four independent arms mounted onto independent surgical carts. Here, we report our initial experience of RALS for rectal cancer surgery by using Hugo. We employ horizontal line port placement (HLPP) at the umbilicus with contralateral reserve arm manipulation (CRAM) technique in which the reserve arm from the left side is manipulated with the operator's right hand, allowing tissue manipulation and tissue dissection with two hands by swapping between reserve and right arms, respectively. The flex-wrist function allows easier handling immediately after swapping. Moreover, HLPP provides sufficient space for the bedside surgeon to provide comfortable assistance. Our procedure of RALS for rectal cancer with Hugo RAS system with HLPP and CRAM technique was safe and feasible.