ICG-guided intracorporeal intestinal diversion with the Hugo™ RAS system following radical cystectomy: technological background and case report

Bernardo Rocco¹, Angelo Totaro¹, Simone Assumma¹, Enrico Panio¹, Filippo Gavi¹, Simona Presutti¹, Pierluigi Russo^1,2, Giovanni Panico³, Filippo Turri¹, Nazario Foschi¹, Anna Fagotti³, Maria Chiara Sighinolfi^1*
1 Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
2 Department of Life Science, Health, and Health Professions, Unilink University, Rome, Italy
3 Department of Woman, Child, and Public Health, Gynecologic Oncology Complex Unit, Gemelli IRCCS, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A, Rome, Italy
* Corresponding Author: Maria Chiara Sighinolfi. Email: sighinolfic@gmail.com

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.067267

Received 29 April 2025; Accepted 10 March 2026; Published online 12 June 2026

Abstract

Background: Robotic radical cystectomy has demonstrated non-inferiority compared with the open approach; however, bowel and uretero-enteric anastomoses remain challenging and prone to complications. Indocyanine Green (ICG) is a fluorescent dye that emits near-infrared light after intravenous administration and enhances the evaluation of tissue perfusion, lymphatic mapping, and anatomical delineation. By allowing real-time assessment of tissue viability, ICG may reduce the risk of anastomotic leakage and ischemic complications. ICG fluorescence was first integrated into the Da Vinci system through Firefly technology, while the Hugo™ Robotic-Assisted Surgery (RAS) platform initially lacked ICG compatibility. We report a preliminary urological application of the recently developed Rubina® ICG fluorescence system integrated with Hugo™ RAS for intracorporeal intestinal diversion following radical cystectomy.
Case Description: A 72-year-old male patient with a BMI of 32 was eligible for robotic-assisted radical cystectomy with intracorporeal ileal conduit using the Hugo™ RAS platform. Rubina® with ICG was employed to assess real-time perfusion of the mesentery, ureters, and anastomosis, confirming adequate vascularization. The combined use of Rubina® on Hugo™ provided clear and versatile imaging, potentially reducing anastomotic complications. Postoperative recovery was uneventful, with no complications or readmissions, and normal renal function was observed at 4 months follow-up.
Conclusions: This case represents a successful use of the Rubina® ICG fluorescence system integrated with Hugo™ RAS for intracorporeal intestinal diversion after radical cystectomy. ICG fluorescence enables real-time perfusion assessment, potentially reducing anastomotic complications. This experience expands the capabilities of the Hugo™ platform and supports the role of fluorescence-guided robotic surgery in complex urologic procedures.