James R. Porter, MD, on how the Hugo RAS system’s energy architecture differs from prior platforms

In this video, James R. Porter, MD, a urologist with Swedish Health Services in Seattle, Washington and chief medical officer for Medtronic Robotic Surgical Technologies and Digital Technologies, describes Hugo's instrumentation as fully wristed with 7 degrees of freedom and motion scaling comparable to established robotic platforms, enabling precise needle positioning and angulation during reconstructive steps such as urethrovesical anastomosis.

On energy delivery, Porter highlights Hugo's use of a power-based electrosurgical architecture, contrasting it favorably with voltage-based systems, which he describes as producing more plume, char, and tissue desiccation—reducing surgical efficiency. He notes that the field has broadly moved back toward power-based energy delivery, and characterizes Hugo's implementation as representative of the current state of the art for robotic and laparoscopic energy systems.

Regarding haptics, Porter clarifies that no current robotic platform—including Hugo—offers true tactile feedback, and that surgeons instead rely on visual haptics: interpreting tissue deformation, firmness, and compliance through visual cues developed over accumulated case experience. He expresses confidence in this approach given the safety record across millions of robotic procedures performed without tactile feedback, while acknowledging that tactile haptic technology is under active development. He notes that its clinical benefit and impact on patient outcomes remain to be established.

Porter contextualizes the 98.5% surgical success rate observed in the Expand URO IDE trial by underscoring that these outcomes were achieved during surgeons' and teams' earliest experience with the platform—a result he attributes directly to structured, assessment-driven preparation. Hugo's training program is built on a proficiency-based progression (PBP) methodology, which Porter describes as distinctive in the robotic surgery space: rather than assuming competency upon completion of training, PBP incorporates formal assessment to verify that learners have achieved defined skill benchmarks. He emphasizes that training extends beyond the console surgeon to encompass the entire operative team, which must be equipped to recognize and manage the platform's differences from incumbent systems. Porter identifies team-level training as the single most critical factor for institutions adopting Hugo, whether as a primary or supplementary robotic platform.