Robotic-Assisted Total Pelvic Exenteration for Rectal Cancer Using the Hugo™ RAS System: First Case Report

Total pelvic exenteration (TPE) is a radical surgical procedure indicated for advanced pelvic malignancies involving adjacent organs. The Hugo™ RAS system, a newly introduced alternative to existing robotic platforms, has not yet been reported for use in TPE for rectal cancer. We present the first known case of robotic-assisted TPE using the Hugo™ RAS system in a patient with locally advanced rectal cancer (LARC) invading the prostate. A 69-year-old male presented with mucous and bloody stools and was diagnosed with cT4b (prostate, levator ani muscle) N0M0 rectal cancer. Following neoadjuvant short-course radiotherapy (25 Gy in 5 fractions), robotic-assisted TPE was performed. Port placement was strategically modified to overlap with the planned colostomy and urostomy sites, minimizing abdominal wall trauma. Radical en bloc resection was performed, and pelvic reconstruction was achieved using a gluteus maximus musculocutaneous flap combined with a fascia lata autograft. Urinary reconstruction was achieved with a robotic intracorporeal Wallace-type ileal conduit. The total operative time was 17 hours and 56 minutes, with an estimated blood loss of 175 mL. The postoperative course was complicated by Clavien–Dindo grade Ⅲa paralytic ileus, which resolved with conservative management. The final pathology showed pT4b (prostate) N1a M0 disease with a negative circumferential resection margin (11 mm). At 9-month follow-up, no recurrence was observed. This case demonstrates the technical feasibility and safety of robotic-assisted TPE using the Hugo™ RAS system. Further clinical experience and long-term follow-up are necessary to establish its reproducibility and oncologic safety.