{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:47:27Z","timestamp":1760060847899,"version":"build-2065373602"},"reference-count":14,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Total pelvic exenteration (TPE) is a radical procedure for advanced pelvic malignancies involving adjacent organs. The Hugo\u2122 RAS System is a novel robotic platform, but its application in TPE has not previously been reported. We describe the first case of robotic-assisted TPE using Hugo\u2122 RAS in a patient with locally advanced rectal cancer invading the prostate. Methods: A 69-year-old male with mucous and bloody stools was diagnosed with cT4b (prostate, levator ani muscle) N0M0 rectal cancer. After short-course radiotherapy (25 Gy\/5 fractions), robotic-assisted TPE was performed. Port placement was planned to coincide with future colostomy and urostomy sites to minimize abdominal wall trauma. En bloc resection was achieved, followed by pelvic reconstruction with a gluteus maximus musculocutaneous flap and fascia lata autograft. Urinary diversion was completed with a robotic intracorporeal Wallace-type ileal conduit. Results: The operation lasted 17 h 56 min, with 175 mL blood loss. Postoperatively, Clavien\u2013Dindo grade IIIa paralytic ileus occurred but was managed conservatively. Pathology revealed pT4b (prostate) N1a M0 disease with negative circumferential margin (11 mm). No recurrence was observed at 9 months. Conclusions: This case highlights the technical feasibility and safety of Hugo\u2122 RAS-assisted TPE. Further clinical experience is needed to confirm reproducibility and oncologic safety.<\/jats:p>","DOI":"10.3390\/jcm14186603","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T12:33:32Z","timestamp":1758285212000},"page":"6603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic-Assisted Total Pelvic Exenteration for Rectal Cancer Using the Hugo\u2122 RAS System: First Case Report"],"prefix":"10.3390","volume":"14","author":[{"given":"Kosuke","family":"Hiramatsu","sequence":"first","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3774-4739","authenticated-orcid":false,"given":"Shigeo","family":"Toda","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1447-3410","authenticated-orcid":false,"given":"Shuichiro","family":"Matoba","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"},{"name":"Division of Colorectal Surgery, Department of General Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omori-Nishi, Ota-ku, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4049-9741","authenticated-orcid":false,"given":"Daisuke","family":"Tomita","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuke","family":"Maeda","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoto","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7262-7975","authenticated-orcid":false,"given":"Yudai","family":"Fukui","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Hanaoka","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0526-6462","authenticated-orcid":false,"given":"Masashi","family":"Ueno","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suguru","family":"Oka","sequence":"additional","affiliation":[{"name":"Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoaki","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroya","family":"Kuroyanagi","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1001\/jama.2017.7219","article-title":"Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: The ROLARR randomized clinical 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