Design: Case report illustrated with video.

Setting: Patient under general anesthesia, placed in lithotomy position, with arms alongside the body and legs 80 degrees abducted in adjustable stirrups. We used 3 robotic arms to access the cavity: one for the optics inserted through the umbilical scar and two incisions in the right and left flanks for robotic arms. The angles chosen during the positioning of the robotic arms were 100º, 260º, and 146º, respectively. The cervix was manipulated with a disposable uterine manipulator.

Patients or Participants: LADS, 36 years old, with three previous pregnancies, two vaginal deliveries and one abortion, presents refractory abnormal uterine bleeding refractory to clinical treatment, causing discomfort and embarrassment. On MRI, the uterus had a volume of 190 cm³, heterogeneus myometrium, with probable subcentimetric intramural leiomyomas. Junctional zone diffusely thickened and irregular, especially in the left fundal region, suggesting adenomyosis.

Interventions: Robotic hysterectomy using Hugo Ras robotic platform.

Measurements and Main Results: The surgery occurred without complications, with a total duration of 100 minutes and an estimated blood loss of 30ml. These metrics highlight the success of the surgery, considering the median total operative time on this platform described in the literature was of 127 minutes (range, 98-255 minutes) and the median estimated blood loss was 50ml (range, 30-125ml). The patient had good postoperative evolution, with no pain complaints in the postoperative period, and was discharged after 1 day.

Conclusion: A potential advantage of Hugo having individual arms is that it allows for eventual changes and adjustments to docking during intraoperative procedures unlike other platforms. Additionally, surgery is performed with excellent image quality 4K, with movement ease similar to other platforms.