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4 The Hugo RAS
TM
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4. Elorrieta V, etal. ROBOT assisted laparoscopic surgeries for nononcological urologic disease:
initial experience with Hugo Ras System. Urology. 2023;174:118–25.
5. Gallioli A, etal. Initial experience of robot-assisted partial nephrectomy with Hugo RAS system: implications for surgical setting. World J Urol. 2023;41(4):1085–91.
6. Carneiro A, Andrade GM. Technology description, initial experience and rst impression of HUGO RAS robot platform in urologic procedures in Brazil. Int Braz J Urol.
2023;49(6):763–74.
7. Prata F, etal. Robot-assisted renal surgery with the new Hugo Ras system: trocar placement
and docking settings. J Pers Med. 2023;13(9):1372.
8. Paciotti M, etal. Nerve-sparing robot-assisted radical prostatectomy with the HUGO robotassisted surgery system using the ‘Aalst technique’. BJU Int. 2023;132(2):227–30.
9. Rocco B, etal. First case of robot-assisted radical cystectomy and intracorporeal neobladder
reconstruction with the Hugo RAS system: step-by-step surgical setup and technique. J Robot
Surg. 2023;17(5):2247–51.
10. Marques-Monteiro M, et al. Extraperitoneal robot-assisted radical prostatectomy with the
Hugo RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery. World J Urol. 2023;41(10):2671–7.
11. Bravi CA, etal. Robot-assisted radical prostatectomy performed with different robotic platforms: rst comparative evidence between Da Vinci and HUGO robot-assisted surgery robots.
Eur Urol Focus; 2023.
12. Bravi CA, etal. Outcomes of robot-assisted radical prostatectomy with the Hugo RAS surgical
system: initial experience at a high-volume robotic center. Eur Urol Focus. 2023;9(4):642–4.
13. Alfano CG, etal. Implementation and outcomes of Hugo(TM) RAS System in robotic-assisted
radical prostatectomy. Int Braz J Urol. 2023;49(2):211–20.
14. Bravi CA, etal. Robot-assisted Radical Prostatectomy with the Novel Hugo Robotic System:
initial experience and optimal surgical set-up at a tertiary referral robotic center. Eur Urol.
2022;82(2):233–7.
15. Mottaran A, etal. Robot-assisted simple prostatectomy with the novel HUGO RAS System:
feasibility, setting, and perioperative outcomes. Minerva Urol Nephrol. 2023;75(2):235–9.
16. Ou YC, etal. Robot-assisted radical prostatectomy using hugo RAS system: the pioneer experience in Taiwan and Northeast Asia. Int J Med Robot. 2023:e2577.
17. Gaya JM, etal. Robot-assisted radical cystectomy and ileal conduit with Hugo(TM) RAS
system: feasibility, setting and perioperative outcomes. Int Braz J Urol. 2023;49(6):787–8.
18. Panico G, etal. The rst 60 cases of robotic sacrocolpopexy with the novel HUGO RAS system: feasibility, setting and perioperative outcomes. Front Surg. 2023;10:1181824.
19. Panico G, etal. HUGO(TM) RAS System in urogynaecology: the rst nerve sparing Sacral
Colpopexy for Pelvic Organ Prolapse. Facts Views Vis Obgyn. 2023;15(1):83–7.
20. Campagna G, etal. Robotic sacrocolpopexy plus ventral rectopexy as combined treatment for
multicompartment pelvic organ prolapse using the new Hugo RAS system. Tech Coloproctol.
2023;27(6):499–500.
21. Balestrazzi E, etal. Comparative analysis of robot-assisted simple prostatectomy: the HUGO
RAS system versus the DaVinci(R) Xi system. Prostate Cancer Prostatic Dis. 2023;27(1):122–8.
22. Bianchi PP, etal. First worldwide report on Hugo RAS surgical platform in right and left colectomy. Updates Surg. 2023;75(3):775–80.
23. Gangemi A, etal. Surgery of the alimentary tract for benign and malignant disease with the
novel robotic platform HUGO(TM) RAS.A rst world report of safety and feasibility. Int J
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RAS surgical platform. BMJ Case Rep. 2023;16(12):e256035.
25. Quijano Y, etal. Robot-assisted Nissen fundoplication with the new HUGO Robotic assisted
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Case Rep. 2023;106:108178.
26. Caputo D, etal. Full robotic cholecystectomy: rst worldwide experiences with HUGO RAS
surgical platform. ANZ J Surg. 2023;94(3):387–90.
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27. Vicente E, etal. Robot-assisted cholecystectomy with the new HUGO robotic-assisted system:
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setup guides and rst-in-human german experience. Visc Med. 2023;39(3-4):76–86.
29. Salem SA, etal. Robotic Heller’s myotomy using the new Hugo RAS system: first worldwide report. Surg Endosc. 2023;38(3):1180–90.
30. Raffaelli M, etal. The new robotic platform Hugo RAS for lateral transabdominal adrenalectomy: a rst world report of a series of ve cases. Updates Surg. 2023;75(1):217–25.
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Y. Mintz and R. Brodie
Versius Surgical Robot
SubhashKhanna andAreendamBarua
5
Introduction
The da Vinci surgical system held the fort of robotic surgery for almost two
decades since its introduction to the market, with very little competition until the
launch of Senhance robotic system in 2016. Unfortunately, Senhance did not fare
favorably against da Vinci, and the company TransEnterix hardly could market
its system in the global market. It was the rst robotic system to introduce independent robotic arms, open platform, haptic feedback, and eye tracking. Even
though there were a lot of innovations being put up by TransEnterix, the da Vinci
S. Khanna (*)
Minimal Access, GI` and Robotic surgery, Swagat Super Speciality Surgical Institute
and NH, Guwahati, Assam, India
A. Barua
Minimal Access and Robotic Surgical Oncology, Swagat Super Speciality Surgical Institute
and NH, Guwahati, Assam, India
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
S. Samreen et al. (eds.), The SAGES Manual of Robotic Surgery,
https://doi.org/10.1007/978-3-031-86927-3_5
43
44
S. Khanna and A. Barua
also evolved continually to maintain its market share. This meant that the da
Vinci-dominated market was indeed a tough nut to crack and needed much more
than innovative technologies only for market appeal. Da Vinci’s strong position
may be attributed to its early entry advantage, technological advancements,
extensive installed base, and market recognition. Versius entered the world of
robotic surgery in 2019. It brought some refreshing changes in that the independent arms were sleeker and much less space-consuming, ergonomic seating with
an open platform, ease of transport to various operating rooms with smaller overall built, and having both lower initial and lower per-use costs. The number of
installed systems in India is around 50, adding to the 160+ installations and over
18,000 procedures performed globally.
System Design
The design of this robotic system is a major game changer in that it has the potential to signicantly increase its reach into robotic minimal invasive surgery.
Versius claims that it is designed to “give surgeons and hospitals the versatility
to operate in the way that’s best for patients and to maximise utilisation.” Let us
dissect into the bold statement of Versius. The Versius is an open-console robotic
system, meaning that the surgeon does not need to dip his head into the immersive surgeon console. This open console with its 3DHD head-up display allows
surgeons to sit or stand. The surgeons can operate in 3D with the help of polarizing passive goggles. Here, the surgeon does not feel being cut off from the rest
of the surgical staff, allows better visual and verbal communication, as well as
improved situational awareness between the surgeon and the larger operative
teams. It supports three compact robotic-independent mobile instrument arms,
apart from the visualization unit that can be shifted between operating theatres
(OTs). A big advantage is that it ts in virtually any operating room, given its
smaller footprint, which is approximately 4.5m2. Also, an assistant surgeon can
t comfortably between the robotic arms in case the need be the robot's wristed
tool tip allows for seven degrees of movement inside the patient, enabling more
surgical access than traditional laparoscopic surgery. It has a high degree of precision with motion scaling (Fig.5.1).
5 Versius Surgical Robot
45
Fig. 5.1 The Versius surgical system components
Components oftheVersius Robotic System
1. One surgeon console
2. One visualization bedside (VBSU) unit and an endoscopic camera
3. Three instrument bedside units (IBSUs)
4. A set of six different surgical instruments
5. Accessories such as a virtual training simulator, drapes, and cables
Now let us learn about each of the components in detail.
Surgeon Console
It is the interface via which the robotic system interacts with the surgeon. It doubles
up as the power hub of the connected bedside units. The console is outside the sterile eld, usually placed at one corner of the operation theatre (OT), at the leg end of
the patient, so as to provide a proper view of the surgical setup. The open-console
design promotes communication between the surgeon and the rest of the surgical
team. The surgeon does not need to scrub for the surgery unless they want to use
staplers or energy devices that Versius does not provide. The surgeon console has a
46
Fig. 5.2 The surgeon
console
S. Khanna and A. Barua
stop button that stops the surgeon console and any connected bedside unit, which is
used to take breaks during long surgeries or to establish communication with the
team. The resume button resumes the system operation (Fig.5.2)
Console Screen The console screen has a 3DHD display, which can be viewed
with polarizing 3D passive glasses. There is also the option of changing the video
feed to 2D.The surgeon has the independence of sitting in a comfortable chair, for
the comfort of the spine, or to stand and operate, given the height-adjustable head up display, making it ergonomically comfortable for the surgeon. An auxiliary
screen (not supplied with the Versius Surgical System) can be connected to the
surgeon console to show a 2D replica of the console screen for the bedside team to
view. The endoscopic camera video feed can be recorded and saved on an SD card,
the slot for which is below the screen.
Updated Console in2024
Very recently, Versius ofcially announced the launch of vLimeLite, the imaging
technology to visualize ICG, which is integrated to the updated version of Versius
surgical robot, Versius Plus. The overlay can be in full color or grayscale. Currently,
the advanced version is available only in the European Union. vLimeLite allows
surgeons to perform visual assessment of the vessels, blood ow, and related tissue
perfusion, as well as biliary anatomy.
5 Versius Surgical Robot
47
Disclaimers
• Product available in the European Economic Area (EEA) only. Please check the
availability of the product with your local sales representative or your local customer service.
• Content provided courtesy of CMR Surgical (© CMR Surgical 2024—Do not
copy or distribute).
• vLimeLite is CE marked. Please check the availability of the product in your
country with your local sales representative or your local customer service. The
Versius System vLimeLite Instructions for Use, including the approved indications, contraindications, and warnings, can be found in the product labeling
supplied with each Versius System. Not available for sale in the United States.
The Head-Up Display (HUD)
The display, in addition to the 3D video output, gives us important information
regarding the system and instrument status. The system icon has a gray background,
and the color of the BSU icons corresponds to the colored LED bands in the instrument arms. The visualization unit has a white background. Icons relating to the
electrosurgery instruments have an extra feature to set them apart from the nonelectrosurgery instruments and allow the surgeon to change between the coagulation (blue) and cut (yellow) modes. The icon color signies the arm we are referring
to, with the same color as the illuminated color bands at the bedside units (Fig.5.3).
In the above image, the HUD shows that the left-hand controller has a fenestrated
grasper mounted on the cyan Versius arm, the orange Versius arm has a needle
holder, and pink Versius arm has curved scissors, both of which have not been
Fig. 5.3 HUD with marked icon locations
48
S. Khanna and A. Barua
assigned to controller and is in the instrument bank, which can be used if need be.
The right-hand controller has the monopolar hook, which is assigned in the coagulation mode, as denoted by blue circle around the hook. Other icons are described in
the gure.
This information is displayed in the auxiliary screen too so that the important
information is displayed for the bedside team too.
Some Important Icons
No Hand-Detected Icon Hand detection is one of the system’s safety features. An
instrument can be engaged with a hand controller only if the hand controller detects
a hand holding it. No hand-detected icons show if one or both the hands are not
detected. When a hand is holding a hand controller, the icon disappears from the
HUD.The instruments will automatically disengage if the hand controllers are left
during the surgery; this is a safety feature (Fig.5.4).
Wind-Up Icon This icon is next to the instrument icon in the form of an arc and
a ball. It gives an indication of the amount of rotation the distal end of the arm
has undergone. The ball moves up and down the arc as the distal end of the arm
rotates away from the neutral position. Once the ball reaches the end of the arc,
the end of the arm cannot rotate any further. This rotation is 360° on either side
(Fig.5.5).
Fig. 5.4 No hand-detected
icons
Fig. 5.5 Curved scissors icons for a pink arm, and the corresponding wind-up icons, indicating
three different degrees of rotation
5 Versius Surgical Robot
49
Alarm Icons
There are two icons: high- and medium-priority icons (Fig.5.6).
There are medium-priority alarms for the arms and for the console. If a mediumpriority alarm occurs, there is no immediate danger to the patient. We can resume
the surgery after taking care of the issue. But we cannot proceed with the surgery if
we encounter a high-priority alarm (Fig.5.7).
Hand Controllers The handgrip is basically like a joystick, with all the controls in
the hands as in a game controller. It was based on extensive ergonomic research and
further developed with surgeon input, which makes maneuvering the surgical instruments as easy as playing a video game. Also, the console has an arm rest for the
elbow to rest while moving the hand controllers in three dimensions. Once the
power is on and the system detects that the hand controllers are being held, the hand
controllers become as light as a feather, precluding any surgeon fatigue for longduration surgeries (Fig.5.8).
Fig. 5.6 Medium-priority
alarm icons
Fig. 5.7 High-priority
alarm icon. High-priority
alarms only occur on arms.
This tells us that there has
been a major dysfunction
and surgery can only
proceed post replacing
the unit
50
Fig. 5.8 The hand
controllers
S. Khanna and A. Barua
Versius Instrument andVisualization Bedside Units
The bedside units consist of a Versius cart and a Versius arm. In the visualization
bedside unit, the instrument is replaced by the endoscopic camera. The Versius arm
is under the control of the surgeon, whereas the cart has to be pushed to the specic
position around the patient prior to surgery (Figs.5.9 and 5.10).
The Versius arm has several parts that are labeled as above. Three key joints
allow the Versius arm to mimic a human arm: base, elbow, and V-Wrist. The
elbow joint can be moved from its position without disturbing the position of the
instrument inside the body to facilitate standing of an assistant surgeon between
two bedside units. The black grip band is used to manually position the instrument inside the patient’s abdomen/thorax before starting the surgery. The joints
are positioned at specic points in space to get specic congurations, each of
which has its importance in specic surgeries or to dissect a particular organ
from a specic position. There are two illuminated colored LED bands on every
arm, which may be any one of the six colors. This helps the surgeon communicate to the surgical staff regarding any issue with the arm. The color of the arm
color identier matches the background color of the HUD icons related to the
arm, its bedside unit, and instrument. There are three V-Wrist buttons on the arm
and one elbow button that are needed to set up the arm for surgery and change
instruments.
The Versius cart is the mobile unit on which the arm is mounted. It has a
control panel at its superior aspect and a cart connection panel at its lower part.
The control panel has height adjustment buttons, low battery indicator (each
bedside unit has its own battery power supply that will support the arm for
20mins if power from the surgeon console is lost), and orientation buttons (they
are used to orient the units to a denite direction, so that the movement of the
arms is as desired by the surgeon). The bedside unit status halo is green when
the robot is functioning normally, which may turn to yellow or red depending on
if the alarm is medium priority or high priority. There are also stop and resume
buttons that stop and resume the unit function, respectively. There is a bedside
unit sleep button, which puts the arm in such a compact conguration so that it
occupies the least space during storage and has the least chance of damage during transportation (Fig.5.11).