First Reported Ivor Lewis Esophagectomy Using the HUGO RAS System in a High-Volume Center: A Technical Feasibility Report and Configurational Setup.

BackgroundRobot-assisted minimally invasive esophagectomy (RAMIE) has become an increasingly utilized approach in the surgical treatment of esophageal cancer. However, widespread use of robotic systems remains limited by high costs and restricted platform availability. The HUGO RAS system represents a novel modular platform with limited data in esophageal surgery.MethodsThis report describes the technical implementation and operative workflow of a robot-assisted Ivor Lewis esophagectomy using the HUGO RAS system. The procedure was performed in a standardized two-stage approach, including an abdominal and thoracic phase. Emphasis was placed on port placement, docking configuration, arm positioning and intraoperative instrument management. Key steps of esophageal mobilization, lymphadenectomy and intrathoracic anastomosis are detailed to illustrate the integration of the system into a complex two-cavity procedure.ResultsThe operation was completed without intraoperative complications or conversion. The described setup provided stable access to both cavities and enabled precise dissection and reconstruction. Oncologic resection achieved negative margins (R0) and 23 lymph nodes were harvested (ypT3 ypN2). The postoperative course was complicated by atrial arrhythmia and pneumonia, both managed successfully. No anastomotic complications occurred and oral intake was resumed without difficulty.ConclusionThis report demonstrates the feasibility of robot-assisted Ivor Lewis esophagectomy using the HUGO RAS system and provides a structured framework for its implementation in complex two-cavity procedures. Its modular design allows flexible docking strategies and a safe operative workflow. These findings may support further adoption of this novel robotic platform in upper gastrointestinal surgery.