Robot-Assisted Uterus-Preserving Colposacropexy Using the HUGO™ RAS System and the “Kiel Duckbill” Technique

H. Fender, A. Merseburger, D. Osmonov

Incontinence, Colposacropexy, HUGO, uterine prolapse, robot-assisted, Kiel duckbill

This video presents a robotically assisted laparoscopic sacrocolpopexy performed with the HUGO RAS System, demonstrating an innovative, uterus-preserving approach to advanced pelvic organ prolapse repair.

The patient presented with first-degree uterine prolapse, third-degree cystocele, and stress urinary incontinence. The procedure highlights a refined surgical strategy that combines the precision and ergonomics of robotic assistance with a distinctive mesh configuration known as the “Kiel duckbill” technique.

A key feature that makes this video particularly worth watching is the unique mesh preparation and placement. After fixation of the proximal mesh end to the sacral promontory, the distal portion is divided into three segments. One segment is secured to the posterior vaginal wall, while the two lateral segments are carefully guided beneath the fallopian tubes, passed through the parametrium, and anchored to the anterior vaginal wall. This creates a balanced, anatomically adapted support structure. The uterus is preserved throughout the procedure, maintaining physiological anatomy while achieving robust apical and anterior compartment support. The peritoneum is subsequently closed to ensure complete mesh coverage.

The video provides a clear, step-by-step demonstration of precise dissection, mesh tailoring, and suturing techniques. Of particular educational value is the detailed visualization of parametrial passage and anterior fixation under robotic magnification, illustrating how complex pelvic anatomy can be managed safely and reproducibly.

By combining advanced robotic technology with an innovative mesh design, this procedure offers a compelling alternative in reconstructive pelvic surgery. Surgeons interested in uterus-preserving prolapse repair and refined mesh techniques will find this video both technically instructive and conceptually inspiring.

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