Operative workflow characterization of the Hugo robotic-assisted surgery and da Vinci Multiport systems in left-sided colorectal surgery: a single-institution pilot analysis

Purpose: The modular four-cart design of the Hugo robotic-assisted surgery (RAS) system raises a practical concern: does it impose a greater operative workflow burden than established platforms? We characterized operative workflow across the Hugo RAS and da Vinci Multiport systems, incorporating a concurrent mature-adoption Multiport cohort as an institutional maturity reference. Methods: This retrospective study analyzed 15 consecutive qualifying cases per cohort: Hugo RAS, initial da Vinci Multiport (de novo adoption), and recent da Vinci Multiport (mature adoption, concurrent with Hugo RAS). Primary endpoints were workflow time intervals across five phases derived from prospectively recorded timestamps. Secondary endpoints included 30-day complications, TME completeness, lymph node yield, and resection margin status. Results: Hugo RAS access phase (27 minutes; IQR, 20-55 minutes) was equivalent to both the initial (p > 0.999) and recent Multiport cohorts (p = 0.693). Nonsurgical time was equivalent between Hugo RAS and recent Multiport cohorts (45 vs. 40 minutes; p = 0.461), operated by the same team at identical institutional maturity. Workflow differences between Hugo RAS and initial Multiport were mirrored by equivalent differences between initial and recent Multiport cohorts-implicating institutional maturity rather than platform effects. TME completeness was 100% in all evaluable cases, and lymph node yield was equivalent across all cohorts (all pairwise p > 0.999). Conclusion: The Hugo RAS four-cart architecture did not impose a greater workflow burden than the da Vinci Multiport system under equivalent institutional conditions. Remaining differences reflected case-mix heterogeneity and asymmetric adoption maturity, supporting continued multi-platform robotic colorectal program development.