Introduction: Robotic surgery has been widely adopted in colorectal surgery worldwide over the last decade, but it is still associated with significant cost. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures using newer robotic platforms. This study aims to present the first case series of colonic splenic flexure resection with the novel platform robotic‐assisted surgery (RAS) Hugo™. Tips for effective setup of the system and detailed configuration of tilt and docking angles are also provided. Methods: Three cases of colonic splenic flexure resection with Hugo RAS™ system are reported. OR setup and port placement allowing for a full robotic resection were used to perform vascular ligation, colonic splenic flexure mobilization, and side‐to‐side linear intracorporeal anastomosis, without the need for re‐docking. Results: Mean docking time was 11 (range 8–14) minutes and the median total operating time was 243 (range 180–350) minutes. Mean estimated blood loss was 116 (range 50–300) mL. No intraoperative complications or conversions were observed. One patient developed postoperative pneumonia. Conclusions: Total robotic splenic flexure resection with Hugo™ RAS system is feasible with good postoperative outcomes. Further studies are needed to confirm our results and to evaluate the surgical strategy and setup.

Per-Oral Endoscopic Myotomy (POEM) is recognized as the first-line therapy for achalasia, considering its high clinical efficacy and safety. Among the most important adverse events, bleeding or hematoma in the submucosal tunnel has incidence of approximately 1%.We describe the case of woman affected by type II achalasia, treated with POEM, who presented delayed bleeding with submucosal hematoma after starting anticoagulant therapy with subcutaneous low molecular weight heparin (LMWH).She presented with moderate-to-severe chest pain, stable vital signs and no evidence of arterial active bleeding. Therefore, urgent esophagogastroduodenoscopy was not performed, and the patient was treated conservatively with fasting, antibiotics, LMWH discontinuation and close medical supervision. After 10 days the condition was resolved, and the patients safely discharged.The present case report adds support to the safety and efficacy of conservative management of submucosal hematomas occurring after POEM.

Background: Robotic surgery represents the most advanced evolution of minimally invasive colorectal procedures. The Hugo™ Robotic-Assisted Surgery (RAS) platform by Medtronic, introduced in 2021, is a novel modular system designed to enhance accessibility and flexibility. Evidence on its application in colorectal procedures remains limited. This study aimed to evaluate the perioperative outcomes of major colorectal resections performed using the Hugo™ RAS system. Methods: A retrospective, consecutive, single-center case series was conducted on all adult patients who underwent major colorectal surgery using the Hugo™ RAS platform between May 2024 and March 2025. Primary endpoints included operative time, docking time, conversions, and intraoperative complications. Secondary endpoints included postoperative complications (classified using Clavien–Dindo), length of stay, time to bowel function recovery, postoperative pain, and readmission. All perioperative variables were standardized with defined measurement criteria, and complication severity was systematically graded. Results: Forty-four patients were included. All surgeries were completed robotically without conversion or intraoperative complications. The median docking time was 11 min, the median console time was 179 min, and the median operative time was 300 min. Four patients (9.1%) developed major complications (Clavien–Dindo III). Right colectomy anastomoses were intracorporeal, performed with a laparoscopic linear stapler through the assistant port due to absence of a robotic stapler. Conclusions: Major colorectal resections performed with the Hugo™ RAS platform were feasible and safe, with satisfactory perioperative outcomes and no conversions. These findings confirm the reproducibility of this novel robotic system in colorectal surgery. Larger prospective multicenter studies with extended follow-up are warranted to further assess long-term and oncological outcomes.