Cross-Platform Comparison of Hugo RAS and da Vinci Xi in Benign Robotic Hysterectomy: Differences in Cost Structure and Operative Time

STUDY OBJECTIVE: To compare perioperative outcomes and hospital cost structure between Hugo RAS and da Vinci Xi for benign simple hysterectomy using a common institutional accounting framework. DESIGN: Retrospective cohort study. SETTING: Single center in Japan PATIENTS: Consecutive patients who underwent benign simple hysterectomy with available financial data. The primary analysis was restricted to procedures performed in 2024-2025, when both robotic platforms were in clinical use. INTERVENTIONS: Robot-assisted benign simple hysterectomy using either da Vinci Xi or Hugo RAS. MEASUREMENTS AND MAIN RESULTS: The primary outcome was total surgical cost. Secondary outcomes included material, labor, drug, and overhead costs; profit and profit margin; operative metrics; estimated blood loss; and 30-day surgical complications. The primary cohort comprised 327 cases: 192 da Vinci and 135 Hugo. Median total surgical cost was 394,012 JPY (approximately 2,542 USD) with da Vinci and 319,091 JPY (approximately 2,059 USD) with Hugo .After adjustment for age, body mass index, prior abdominal surgery, endometriosis, uterine weight, surgery year, and surgeon, the cost ratio for total surgical cost (Hugo/da Vinci) was 0.83 (95% CI, 0.80-0.87). Material cost accounted for most of the difference, with an adjusted cost ratio of 0.75 (95% CI, 0.71-0.79). Adjusted labor, drug, and overhead costs showed no clear differences. Hugo was associated with longer operative time (adjusted mean difference, 9.4 minutes; 95% CI, 4.0-14.8) and console time (5.6 minutes; 95% CI, 1.9-9.3). No 30-day complications were recorded in either group. CONCLUSION: For benign simple hysterectomy, Hugo RAS was associated with lower hospital cost than da Vinci Xi, largely because of lower material cost, despite longer operative and console times.