Introduction: Less than 1 year ago, the new robotic system Hugo RAS (Medtronic, Minneapolis, MN, USA) was approved for general surgery. It introduced the novelty of utilizing independent robotic arms in a multimodular system, providing versatility for performing increasingly complex surgeries that require different angles.

Methods: All patients scheduled for unilateral or bilateral inguinal hernia repair, over 18 years of age, were included. Unlike other reports, there were no exclusion criteria for it, that is, the patient was taken into account regardless of elderly status, recidivated hernia or high body mass index (BMI). Peri and postoperative outcomes were prospective collected and analysed.

Results: A total of 42 inguinal hernia repairs were performed using the HUGO system in 25 patients, including 17 bilateral inguinal hernias and 8 unilateral hernias. The average docking time was 5.4 minutes (range: 4.3-7.8 minutes). The average console time was 67.9 minutes for bilateral repairs and 31.3 minutes for unilateral repairs. The average total procedure time was 113.1 minutes for bilateral repairs and 52.2 minutes for unilateral repairs. No intraoperative complications were encountered, and all patients were discharged the day after surgery according to the institutional protocol. In postoperative follow-up, one elderly patient presented with an inguinal hematoma.

Conclusions: The HUGO RAS system is safe, reproducible, and suitable for complex hernias. We have introduced an alternative guide setup for this surgery. Our series represents the first patient series in Europe and the second worldwide.