Abstract
Evidence on Hugo RAS in bariatric surgery remains limited. We evaluated the first 100 Hugo RAS small bowel length shortening with sleeve gastrectomy (BOS-SG) procedures to determine whether surgeon-level technical performance (console time) and team-level workflow (docking time) evolved differently during implementation. This retrospective single-center cohort included consecutive cases performed between February 11 and July 30, 2025. Change points were assessed using segmented linear regression, Davies tests, 95% confidence intervals, and descriptive cumulative sum (CUSUM) analysis. Early and late phases were defined by the rounded docking-time breakpoint, the most stable interpretable workflow transition. Among 100 cases, median console time was 16.0 min (interquartile range [IQR], 15.0-21.2) and docking time was 5.0 min (IQR, 3.0-5.2). CUSUM peaks occurred at cases 24 and 28, respectively. Segmented regression identified a docking-time breakpoint at case 33.1 (95% CI, 26.2-40.0; Davies p < 0.001); the console-time segmented solution was early and was not retained. From early to late phase, console time decreased from 23.0 to 16.0 min (p < 0.001), docking time from 6.0 to 4.0 min descriptively, and total operative time from 95.0 to 77.0 min (p < 0.001). Complications occurred in 1/33 and 7/67 cases (p = 0.265). Hugo RAS BOS-SG implementation showed distinct, complementary learning trajectories. Docking time, a team-workflow metric, demonstrated the most stable transition around 30-40 cases, whereas console performance improved without a stable mid-series breakpoint. Console and docking time should be treated as noninterchangeable endpoints for platform adoption.