Design: Descriptive Video

Setting: Under general anaesthesia, the patient was placed in the dorsal lithotomy position with both legs supported by Allen stirrups with a Trendelenburg tilt and arms positioned along the body. The adjustable robotic arms could be individually positioned in different arrangements in space, detached from one another. In our setting, we decided to use three robotic arms, one for the endoscope, and the remaining two for three different instruments: bipolar fenestrated grasper on the left arm, monopolar curved scissors on the right arm, and during the colporrhaphy, a large-needle driver on the right arm after removal of curved scissors.

Patients or Participants: A 42-year-old female patient with no significant pathological or surgical history. Obstetric history includes two pregnancies and two vaginal deliveries (G2P2). She presented with complaints of severe menorrhagia, which was resistant to conventional medical management. Subsequently, she underwent diagnostic assessments, including an ultrasound and Magnetic Resonance Imaging (MRI), which identified diffuse adenomyosis as the underlying cause. After a thorough discussion of the available treatment options, the patient opted for a surgical management. She elected to undergo a total hysterectomy accompanied by bilateral salpingectomy, utilizing a robotic-assisted surgical approach. Consequently, the patient was scheduled for a robotic-assisted total hysterectomy.

Interventions: Total hysterectomy was performed step-by-step, according to the described technique

Measurements and Main Results: The Hugo™ RAS system is an effect and safe alternative approach to total hysterectomy.

Conclusion: Total hysterectomy is a complex surgery composed of surgical space preparation, coagulation and cutting of vessels and ligaments, and excisional and reconstructive steps that allow testing of various surgical performances of the Hugo™ RAS.