Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements

A comparative analysis of perioperative outcomes in single-port and multi-port retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis

The retroperitoneal approach for RAPN minimizes interference with intraperitoneal organs but is constrained by a restricted operating space. The single-port (SP) robotic platform excels in navigating tight anatomical environments compared to the multi-port (MP) robotic system. However, there are not many studies that compare the results of surgery using these two platforms when the retroperitoneal approach is used. To address this difference, a detailed review of current studies was done to compare the results of SP-RAPN and MP-RAPN surgeries that were performed using the retroperitoneal method. A comprehensive search was conducted in the databases of PubMed, Web of Science, the Cochrane Library, and SpringerLink to identify any studies that compare urgent-start PD versus urgent-start HD prior to November 25th, 2024. To compare SP-RAPN to MP-RAPN, we looked at things like operation duration, expected blood loss, length of stay, ischemia time, all complications, PSMs, and pathological stage. This meta-analysis incorporated four studies involving a total of 728 patients. Our findings showed no notable distinctions in operative time (WMD - 4.75 min, 95% CI - 12.05 to 2.55, p = 0.20), ischemia time (WMD 3.01 min, 95%CI - 1.32 to 7.34, p = 0.17), blood loss (WMD -3.53 ml, 95% CI - 18.01 to 10.95, p = 0.63), hospital stay duration (WMD - 0.23 days, 95% CI - 0.69 to 0.23, p = 0.32), or overall complication rates (OR 0.34, 95%CI 0.11 to 1.04, p = 0.06) between SP-RAPN and MP-RAPN. Additionally, there was no significant variation in the incidence of positive surgical margins (OR 0.74, 95%CI 0.33 to 1.65, p = 0.46) or in the distribution of postoperative pathological stages, including pT1a (OR 1.22, 95%CI 0.81 to 1.82, p = 0.35), pT1b (OR 0.65, 95%CI 0.39 to 1.06, p = 0.08), and stages ≥ pT2 (OR 1.13, 95%CI 0.54 to 2.38, p = 0.75). While single-port robotic systems provide notable operational advantages in confined spaces, our meta-analysis shows no significant differences between SP-RAPN and MP-RAPN in terms of operative time, intraoperative blood loss, hospital stay, ischemia time, complication rates, and positive surgical margins when both techniques are used for retroperitoneal resection of non-complex renal tumors. Future large-scale randomized controlled trials are required for long-term follow-up to further validate these findings.

Comparative short-term efficacy and safety analysis of a single-port robot in nephrectomy

The objective of the study is to conduct a systematic assessment of the clinical effectiveness differences between single-port and multi-port robotic surgical systems in the context of renal tumor removal, grounded in evidence-based medical data. Adhering to PRISMA standards, a comprehensive literature search was executed across PubMed, Embase, Cochrane Library, and Web of Science from their inception until March 2025. The search included randomized controlled trials and cohort studies that compared single-port and multi-port robotic systems for partial or radical nephrectomy. Statistical analysis of the outcomes was carried out using Stata 15.0, with the results presented as weighted mean difference (WMD) and odds ratio (OR). Subgroup analyses were conducted to examine the consistency of the findings with respect to thermal ischemia duration. A combined analysis of 11 studies, comprising 1729 participants, were analyzed, with 654 individuals in the single-port cohort and 1075 in the multi-port cohort. The meta-analysis revealed a significantly shorter hospital stay for the single-port cohort compared to the multi-port cohort (WMD = -0.32, 95% CI -0.47, -0.17, p < 0.05). However, the single-port cohort also experienced a longer thermal ischemia time (WMD = 2.92, 95% CI 0.45, 5.38, p < 0.05). No statistically significant differences were found between the two cohorts regarding complication rates, intraoperative blood loss, operative time, positive margin rates, conversion rates, or tumor recurrence rates. Single-port robotic nephrectomy for renal tumors can enhance postoperative recovery without compromising oncologic safety. Nevertheless, its effect on renal function preservation requires careful evaluation. Future investigations ought to encompass extended, high-caliber studies to offer more substantial data for clinical choices.

Retroperitoneal single port vs. transperitoneal multiport robot assisted partial nephrectomy in patients with highly hostile abdomen: comparative analysis from a tertiary care center

BACKGROUND

The aim of this study was to explore perioperative and functional outcomes in a cohort of patients with highly hostile abdomens treated with retroperitoneal (RP) single port vs transperitoneal multiport robot assisted partial nephrectomy.

METHODS

Clinical and surgical data of all consecutive patients treated with transperitoneal multiport and RP single-port robot assisted partial nephrectomy between March 2019 and January 2024 were prospectively collected and retrospectively analyzed. The presence of "hostile abdomen" was defined as personal history of at least one major abdominal surgery. Multivariable logistic regression analysis was used to assess independent predictors of Trifecta achievement.

RESULTS

Overall, clinical and surgical data of 247 consecutive patients were prospectively collected, of these 71 met the inclusions criteria and were retrospectively analyzed. No differences emerged in baseline features. Previous surgery proximity to the site of partial nephrectomy was found comparable among groups (P=0.21). RP single port group showed a significantly lower operative time (171 vs. 235 min, P=0.02) and estimated blood loss (70 vs. 100 cc, P=0.04) while open conversion was significantly higher (9.3%) in case of multiport treatment (P=0.001). A significative lower rate of major postoperative complications (7.1% vs. 16.3%, P=0.03) as well as 90-days readmissions (P=0.04) was found in case of single port RP procedures. Adjusting for age, BMI and CCI, RP single port approach was confirmed as independent predictor of Trifecta achievement (OR 1.62 CI 1.18-2.35 P=0.01).

CONCLUSIONS

In patients treated with RAPN with highly hostile abdomens, the adoption of a single port RP approach reduces the major complication rate as compared to the multiport transperitoneal approach also improving EBL, operative time, LOS and pain management.

Single-Port vs Multiport Robotic Surgery in Urologic Oncology: A Narrative Review

Introduction: Robotic surgery has improved the oncologic and functional outcomes of many urologic oncology procedures by optimizing visualization and instrument maneuverability. Since its FDA approval in 2018, the daVinci single-port (SP) platform has become increasingly utilized in urologic oncology, with its theoretical advantages over the standard multiport (MP) platform including improved cosmesis, reduced pain, and shorter hospitalization. Given this platform's relative novelty, comparisons between SP and MP robotic surgeries in urologic oncology tend to be small, non-randomized studies performed at centers of excellence. We review the existing literature comparing oncologic and functional outcomes between SP and MP surgeries to treat prostate, kidney, and bladder cancer. Methods: A literature review was performed in PubMed for studies comparing SP and MP prostatectomies, nephrectomies, and cystectomies from 2018 to 2024. The search was limited to English studies. Studies evaluating prostatectomy, nephrectomy, and cystectomy for nononcologic indications were excluded. Results: No difference in margin status or recurrence was definitively demonstrated between SP and MP radical prostatectomy, partial nephrectomy, or radical cystectomy. No clear difference in operative time, blood loss, or complication rates between SP and MP surgery was found. SP surgery may improve length of stay, pain, and satisfaction with incisions compared with MP surgery, though these differences were not robustly demonstrated across all studies. Key functional outcomes, such as change in kidney function in partial nephrectomy, and erectile/urinary function in radical prostatectomy, were similar between the SP and MP platforms. Conclusion: Based on current evidence from experienced surgeons at centers of excellence, the daVinci SP platform allows urologists to perform common oncologic procedures safely and effectively. Currently, no data definitively establishes improved oncologic or functional outcomes for SP surgery over MP surgery, though improved hospital stay and cosmesis are identified as theoretical benefits of an SP procedure.

Adoption of Single-Port Robotic Partial Nephrectomy Increases Utilization of the Retroperitoneal Approach: A Report from the Single-Port Advanced Research Consortium

Introduction: Retroperitoneal approach for robotic partial nephrectomy (PN) has been shown to offer shorter operative times and hospital stays without differences in complication rates compared with the transperitoneal approach. The single-port (SP) system may be better suited than multiport (MP) for challenges with the retroperitoneal approach such as narrow access geometry. We evaluated if the adoption of SP PN increased the utilization of retroperitoneal approach. Methods: We retrospectively reviewed an IRB-approved multi-institutional database of all PN from 2013 to 2023. The date of the first SP PN split the cohorts before and after SP adoption. The percentage of retroperitoneal and transperitoneal approach cases overall and for SP and MP was determined before and after adoption. Joinpoint analysis assessed changes in rates of the retroperitoneal approach. Logistic regression compared patient and tumor characteristics with retroperitoneal approach PN before and after adoption of SP. Results: Overall 1959 patients were evaluated, of which 654 were performed prior versus 1305 after SP adoption. There was an increased percentage of retroperitoneal approach after adoption, with 7.3% (48/654) before compared with 24.8% (324/1305) after adoption. The percentage of the retroperitoneal approach for SP PN was 52.8% (134/254), increasing over time with 75% (24/32) of SP in 2023 performed with a retroperitoneal approach. Conclusion: The retroperitoneal approach was used more frequently than the transperitoneal approach in the SP cohort. The adoption of SP increased the incidence of the retroperitoneal approach.

Narrative Review of Single-Port Surgery in Genitourinary Cancers

BACKGROUND

The da Vinci single-port (SP) platform is emerging as the latest innovation in minimally invasive surgery and its utilization in treating urologic malignancies continues to expand.

METHODS

A search was conducted in PubMed, MEDLINE, and ScienceDirect. The final set includes 40 academic articles.

RESULTS

Research on single-port surgery for genitourinary cancer is still an emerging topic. We divided the topic into the following categories: radical prostatectomy, radical cystectomy, nephrectomy, and nephroureterectomy.

CONCLUSIONS

The single-port platform provides urologists with another tool to tackle more complex surgical cases and pathologies with the added improvements of decreased length of stay and increased pain tolerance for patients.

Comparison of outcomes between single-port and multiport retroperitoneal robotic partial nephrectomy

INTRODUCTION

Single-port (SP) robotic surgical system performs well in small anatomical spaces, which makes it suitable for retroperitoneal robotic partial nephrectomy (RPN). However, there is limited evidence comparing the safety and feasibility of SP RPN to multiport (MP) RPN. To address this gap in evidence, we sought to analyze and compare the safety of retroperitoneal RPN between SP and MP approaches.

METHODS

This is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) and a multicenter database of patients who underwent retroperitoneal RPN using either SP or MP between 2017 and 2023. Baseline, perioperative, and postoperative data were compared using t-tests, Mann-Whitney U test, χ2 test, and Fisher exact test. Multivariable analyses were conducted using robust and Poisson regressions.

RESULTS

A total of 286 patients (SP RPN, n = 86 [30%]; MP RPN, n = 200 [70%]) underwent retroperitoneal RPN. R.E.N.A.L nephrometry score and tumor location were significantly different between the 2 groups. Notably, the ischemia time was significantly shorter in the MP group (16 vs. SP, 22 minutes, P < 0.001). Adjusting for baseline characteristics, the ischemia time was approximately 7.89 minutes longer for patients in the SP group compared to the MP group, on average (95% CI: 5.87, 9.92; P < 0.001). No significant differences were observed in operative time, EBL, blood transfusion, conversion rates, LOS, PSM, and overall 30-day postoperative complications between the 2 groups.

CONCLUSION

Our study shows that retroperitoneal SP and MP RPN have comparable perioperative and postoperative outcomes, except for the longer ischemia time in the SP platform. SP RPN is a safe and viable alternative; however, further research is needed to explore its potential benefits, cost-effectiveness, and long-term oncologic outcomes.

Robotic-assisted surgery for the treatment of urologic cancers: recent advances

INTRODUCTION

Recent advancements in single-port surgery, robotic platforms, 3D models and artificial intelligence have transformed surgical procedures, especially in urology. These innovations enhance precision, safety, and efficacy, reducing invasiveness and recovery times. The review focuses on the latest in robotic-assisted surgery for genitourinary cancers, highlighting the shift toward personalized, minimally invasive treatments.

AREAS COVERED

A bibliographic search across PubMed, Scopus, and EMBASE databases focused on the last four years of innovations in robotic surgery for urologic tumors. The review highlights the use of the Da Vinci Single Port robotic system, available robotic platforms worldwide, advancements in 3D virtual models, artificial intelligence in robotic surgery and the application of molecular imaging for assessing primary lymph nodes and treating lymph node metastases and local recurrences in prostate cancer.

EXPERT OPINION

The integration of single-port surgery, new robotic platforms, 3D models and artificial intelligence in urological oncology promises transformative impacts on diagnosis, treatment and cost-effectiveness. Despite benefits like enhanced precision and expanded surgical access, challenges such as high costs, training needs, and technological integration barriers persist. Collaboration and further research are critical to optimize outcomes, improve safety protocols, and ensure equitable global access to these innovations.

Comparison of outcomes between single-port and multi-port robotic radical nephrectomy

Single-port (SP) robotic surgery is a novel technology, and although there is emerging data, it remains limited in assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. To compare perioperative and postoperative outcomes between SP and MP robotic technologies for radical nephrectomy (RN). This is a retrospective cohort study of patients who have undergone robot-assisted radical nephrectomy using either the SP or MP technology. Baseline demographics, clinical, tumor-specific characteristics, and perioperative and postoperative outcomes were compared using χ2, t-test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust, Poisson, and logistic regressions. A total of 341 patients underwent robotic RN with 47 patients (14%) in the SP group. The two groups exhibited similar baseline characteristics, with no significant differences in age, sex, body mass index, Charlson comorbidities index, and tumor laterality. However, SP group had a smaller average tumor size (5.1 cm vs 6.4 cm, p = 0.009). The SP had longer operative time (178 ± 84 min vs 142 ± 75 min; p = 0.011) but showed no significant difference in the estimated blood loss, blood transfusion rate, length of stay, overall 30-day and major complication rates. Controlling for other variables, SP was significantly associated with a longer operative time and shorter length of stay. SP is associated with longer operative time but offers advantages such as smaller incisions and shorter hospital stays with a comparative safety profile to MP for radical nephrectomy.

Meta-analysis and systematic review of factors predicting conversion to radical nephrectomy following robotic-assisted partial nephrectomy in renal cancer patients

Evaluating the risk factors for the conversion from robotic-assisted partial nephrectomy (RAPN) to radical nephrectomy (RN). Through a comprehensive database search encompassing PubMed, Web of Science, Embase, and the Cochrane Library, we identified pertinent English-language research published by June 2024. We utilized the NOS scale for quality assessment. The aggregate effect was quantified via the odds ratio (OR), alongside a 95% confidence interval (CI). Sensitivity analyses were conducted using both fixed-effects and random-effects models to evaluate reliability. The meta-analytical process was facilitated by the Stata 18 software suite. Our meta-analysis encompassed a total of 8 retrospective studies and 3 prospective studies, totaling 4056 patients. We found that increasing patient age (OR: 1.04; 95% CI 1.00-1.08; P = 0.005), higher American Society of Anesthesiologists (ASA) scores (3 or above) (OR: 2.74; 95% CI 1.52-4.93; P = 0.001), elevated R.E.N.A.L. scores (7 or above) (OR: 2.49; 95% CI 1.57-3.95; P < 0.001), and the use of off-clamp RAPN (OR: 7.21; 95% CI 2.60-19.93; P < 0.001) significantly raised the odds of surgical conversion. On the other hand, male sex (OR: 1.04; 95% CI 0.67-1.62; P = 0.858), the side of the tumor (OR: 0.97; 95% CI 0.48-1.95; P = 0.936), tumor size (OR: 3.43; 95% CI 0.57-20.55; P = 0.177), body mass index (BMI) (OR: 1.03; 95% CI 0.96-1.11; P = 0.426), clinical stage (OR: 3.78; 95% CI 0.46-30.70; P = 0.214), and the use of single-port RAPN (OR: 0.54; 95% CI 0.16-1.78; P = 0.31) did not show a statistically significant link to an increased conversion risk. This meta-analysis elucidates the critical risk factors for the conversion from robotic-assisted partial nephrectomy to radical nephrectomy, providing significant guidance for preoperative risk assessment and clinical decision-making. However, our findings necessitate validation through studies with larger sample sizes.

Comparison of single-port versus multi-port robotic assisted partial nephrectomy: a systematic review and meta-analysis of perioperative and oncological outcomes

The safety and efficacy of single-port and multi-port robot-assisted partial nephrectomy (SP-RAPN and MP-RAPN, respectively) were assessed for treating partial nephrectomy in this study. A systematic review of PubMed, Cochrane Library, and Web of Science databases was conducted up to June 2024 to compare studies on SP-RAPN and MP-RAPN. Primary outcomes included perioperative results, complications, and oncological outcomes. Eight studies involving 1014 patients were analyzed. For binary outcomes, comparisons were performed using odds ratios (OR), and for continuous variables, weighted mean differences (WMD) with 95% confidence intervals (CI). The search failed to discover significant meaningful variations in operating times (p = 0.54), off-clamp procedure (P = 0.36), blood loss (p = 0.31), positive surgical margins (PSMs) (p = 0.78), or major complications (Clavien-Dindo grade ≥ 3) (p = 0.68) between SP-RAPN and MP-RAPN. However, shorter hospital stays (WMD - 0.26 days, 95% CI - 0.36 to - 0.15; p < 0.00001) and longer warm ischemia times (WIT) (WMD 3.13 min, 95% CI 0.81-5.46; p = 0.008) were related to SP-RAPN, and higher transfusion rate (OR 2.99, 95% CI 1.31-6.80; p = 0.009) compared to MP-RAPN. SP-RAPN performed better in terms of hospital stay but had slightly higher rates of transfusion, off-clamp procedures, and warm ischemia time (WIT) compared to MP-RAPN. As an emerging technology, preliminary research suggests that SP-RAPN is a feasible and safe method for carrying out a nephrectomy partial. However, compared to MP-RAPN, it shows inferior outcomes regarding (WIT) and transfusion rates.

Comparison of lateral flank approach and low anterior access for single port (SP) retroperitoneal partial nephrectomy: an analysis from the single port advanced research consortium (SPARC)

Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to compare outcomes of two commonly described incisions for retroperitoneal SP RPN: lateral flank approach (LFA) and low anterior access (LAA). We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 to 2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, t test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust and logistic regressions. A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. Overall, there were no significant differences in baseline characteristics between the two groups. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, p < 0.001) and more varied tumor locations (p = 0.002). In the bivariate analysis, there were no statistically significant differences in ischemia time, estimated blood loss, or complication rates between the groups. However, the LAA group had longer operative times (101 vs. 134 min, p < 0.001), but was more likely to undergo a same-day discharge (p < 0.001). When controlling for other variables, LAA was associated with shorter ischemia time (p = 0.005), but there was no significant difference in operative time (p = 0.348) and length of stay (p = 0.122). Both LFA and LAA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes. This early data suggests the LAA is more versatile for varying tumor locations; however, larger cohort studies are needed to ascertain whether there is an overall difference in patient recovery.

Postoperative Outcomes and Analgesic Requirements of Single-Port vs Multiport Robotic-Assisted Radical Cystectomy

Objective: To compare outcomes in patients undergoing robotic-assisted radical cystectomy (RARC) with urinary diversion for bladder cancer with either the single-port (SP) or multiport (MP) robotic platform. Methods: All patients who underwent SP and MP RARC at our institution between January 2018 and January 2023 were retrospectively reviewed. Postoperative analgesia was administered by a departmentwide narcotic stewardship protocol, and inpatient and outpatient narcotic use was tracked. The available preoperative clinical, operative, and postoperative outcomes were analyzed using t-test, chi-square, and Fischer exact statistical measures. Kaplan-Meier analysis with log-rank testing was used to determine the freedom from high-grade (Clavien-Dindo grade ≥3) postoperative complications stratified by SP or MP robotic use. Results: Overall, 96 patients underwent RARC with urinary diversion at our institution, with 49 MP and 47 SP procedures performed. Preoperative clinical parameters including age, body mass index, prior abdominal surgery, and use of neoadjuvant chemotherapy were similar between the two groups. Patients undergoing SP RARC had a shorter operative time (386.0 ± 90.9 minutes vs 453.6 ± 94.8 minutes, p < 0.01) and faster return of bowel function (3.4 ± 1.4 days vs 4.5 ± 2.2 days, p < 0.01). However, both cohorts had similar length of hospitalization, postoperative narcotic use, pathologic staging, and rate of positive surgical margin. Within 3 months postoperatively, both cohorts had a similar high-grade complication, hospital readmission, and cancer recurrence rate. Conclusions: The SP robot allows a safe alternative surgical approach for RARC and offers similar postoperative outcomes compared to the MP robot.

Single-Port vs Multiport Robot-Assisted Partial Nephrectomy: A Meta-Analysis

Background: Several centers have reported their experience with single-port robot-assisted partial nephrectomy (SP-RAPN); however, it is uncertain if utilization of this platform represents an improvement in outcomes compared to multiport robot-assisted partial nephrectomy (MP-RAPN). To evaluate this, we performed a meta-analysis to compare the perioperative, oncological, and functional outcomes between SP-RAPN and MP-RAPN. Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until January 1, 2023. A meta-analysis has been reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and assessing the methodological quality of systematic reviews (AMSTAR) guidelines. The odds ratio (OR) and weighted mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results: Of the 374 retrieved abstracts, 29 underwent full-text review, and 8 studies were included in the final analysis, comprising a total cohort of 1007 cases of RAPN (453 SP-RAPN cases and 554 MP-RAPN cases). Compared to MP-RAPN, the SP-RAPN group had a significantly longer ischemia time (MD = 4.6 minutes, 95% CI 2.8 to 6.3, p < 0.001), less estimated blood loss (MD = -12.4 mL, 95% CI -24.6 to -0.3, p = 0.045), higher blood transfusion rate (OR = 2.97, 95% CI 1.33 to 6.65, p = 0.008), and higher postoperative estimated glomerular filtration rate (eGFR) at 6 months (MD = 4.9 mL/min, 95% CI 0.2 to 9.7, p = 0.04). There was no significant difference in other outcomes between the two approaches, including the intraoperative complication, overall postoperative complication, minor postoperative complication (Clavien-Dindo I - II), major postoperative complication (Clavien-Dindo III-V), conversion to radical nephrectomy, pain score on day #1, pain score on discharge, morphine milligram equivalent usage, hospital stay, positive surgical margins, and postoperative eGFR. Conclusions: SP-RAPN represents an emerging technique using a novel platform. Initial studies have demonstrated that SP-RAPN is a safe and feasible approach to performing partial nephrectomy, although with inferior outcomes for ischemia time and blood transfusion rates. Further studies will be necessary to define the best usage of SP-RAPN within the surgeon's armamentarium.

Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis

OBJECTIVE

Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries.

METHODS

A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis.

RESULTS

There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = - 0.63, 95% Cl [- 1.06, - 0.21], P < 0.05), less estimated blood loss (WMD = - 19.56, 95% Cl [- 32.21, - 6.91], P < 0.05), less lymph node yields (WMD = - 3.35, 95% Cl [- 5.16, - 1.55], P < 0.05), less postoperative opioid use (WMD = - 5.86, 95% Cl [- 8.83, - 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate.

CONCLUSION

Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.

Transperitoneal Versus Retroperitoneal Single-port Robotic-assisted Partial Nephrectomy: An Analysis from the Single Port Advanced Research Consortium

BACKGROUND

In the surgical management of kidney tumors, such as in multiport technology, single-port (SP) robotic-assisted partial nephrectomy (RAPN) can be performed using the transperitoneal (TP) or retroperitoneal (RP) approach. However, there is a dearth of literature on the efficacy and safety of either approach for SP RAPN.

OBJECTIVE

To compare the peri- and postoperative outcomes of the TP and RP approaches for SP RAPN.

DESIGN, SETTING, AND PARTICIPANTS

This is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) database of five institutions. All patients underwent SP RAPN for a renal mass between 2019 and 2022.

INTERVENTION

TP versus RP SP RAPN.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Baseline characteristics, and peri- and postoperative outcomes were compared between both the approaches using χ2 test, Fisher exact test, Mann-Whitney U test, and Student t test.

RESULTS AND LIMITATIONS

A total of 219 patients (121 [55.25%] TP, 98 [44.75%] RP) were included in the study. Of them, 115 (51.51%) were male, and the mean age was 60 ± 11 yr. RP had a significantly higher proportion of posterior tumors (54 [55.10%] RP vs 28 [23.14%] TP, p < 0.001), while other baseline characteristics were comparable between both the approaches. There was no statistically significant difference in ischemia time (18 ± 9 vs 18 ± 11 min, p = 0.898), operative time (147 ± 67 vs 146 ± 70 min, p = 0.925), estimated blood loss (p = 0.167), length of stay (1.06 ± 2.25 vs 1.33 ± 1.05 d, p = 0.270), overall complications (5 [5.10%] vs 7 [5.79%]), and major complication rate (2 [2.04%] vs 2 [1.65%], p = 1.000). No difference was observed in positive surgical margin rate (p = 0.472) or delta eGFR at median 6-mo follow-up (p = 0.273). Limitations include retrospective design and no long-term follow-up.

CONCLUSIONS

With proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes.

PATIENT SUMMARY

The use of a single port (SP) is a novel technology for performing robotic surgery. Robotic-assisted partial nephrectomy (RAPN) is a surgery to remove a portion of the kidney due to kidney cancer. Depending on patient characteristics and surgeons' preference, SP can be performed via two approaches for RAPN: through the abdomen or through the space behind the abdominal cavity. We compared outcomes between these two approaches for patients receiving SP RAPN, finding that they were comparable. We conclude that with proper patient selection based on patient and tumor characteristics, surgeons can opt for either the TP or the RP approach for SP RAPN, and maintain satisfactory outcomes.

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses

There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.

Early perioperative outcomes of single-port compared to multi-port robot-assisted laparoscopic partial nephrectomy

Single-port (SP) robot-assisted laparoscopic partial nephrectomy (RAPN) is a promising new technique. The aim of this study was to compare surgical and oncological outcomes of SP-RAPN to the multi-port (MP) surgical platform. This is a retrospective, cohort-based study involving patients undergoing SP-RAPN between 2019 and 2020 at a single institution. Demographic, preoperative, surgical, and postoperative outcomes data were gathered and compared to a 1-to-1 matched MP cohort. A total of 50 SP and 50 matched MP cases were included. Length of surgery and ischemia time were not statistically significant between the two cohorts; however, estimated blood loss (EBL) was significantly lower in the SP group than in the MP (IQR 25-50 vs. IQR 50-100 mL, p = 0.002). No differences were seen in regard to the 30-day readmission rate, surgical margin status, pain scores, and complications between the two approaches. We found no statistically significant differences in positive margins, pain score, length of stay, or readmission rate between matched SP and MP patients. These data support the viability of the SP technique as an alternative to MP-RAPN when in the hands of experienced surgeons.

How far has robot-assisted partial nephrectomy reached?

Nephron-sparing surgery is the standard treatment for small renal mass (SRM). Nephron-sparing surgery has evolved from an open to a minimally invasive technique. Robot-assisted partial nephrectomy (RAPN) is the latest technique in this field and is reported to be safe and feasible, showing oncologically and functionally superior or compatible results compared with open and laparoscopic partial nephrectomy for SRM. This is not limited to only SRM but also applies to large and complex renal masses and other challenging situations. RAPN showed good oncological and functional outcomes for ≥clinical T2 renal tumors, complex renal masses (PADUA score ≥10, RENAL score ≥10), hilar renal tumors, and multiple renal tumors. In addition, the outcomes of RAPN in these challenging cases were not inferior to those in conventional cases. RAPN could also be applied to a number of challenging cases in which the open technique was considered first. RAPN showed good results in patients with a solitary kidney, horseshoe kidney, and in repeat surgeries. Furthermore, RAPN could be safely performed on obese, elderly, and pediatric patients. Finally, this review evaluates efficiency and utility of RAPN based on the results of challenging cases of renal masses and to project the future of RAPN.

Single-Port Robotic Applications in Urology

Objective: The da Vinci single-port (SP) platform represents the latest innovation in minimally invasive urologic surgery, and the adoption of this technology by urologists is increasing. In this article, we briefly describe the evolution of minimally invasive and single-site surgery, and offer a comprehensive review of the current literature on the SP platform. Materials and Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until August 15, 2022. The published literature to date within SP robotic surgery in urology will be discussed. Evidence Synthesis: There are relatively few high-quality studies on the SP system, but there are multiple case series describing unique indications and surgical approaches with the SP robot, demonstrating safety and feasibility in the hands of experienced robotic surgeons. There also are an increasing number of prospective, larger cohort studies comparing outcomes between SP and multiport (MP) approaches that show benefits of the SP system regarding improved cosmesis, postoperative pain control, and decreased length of stay. Conclusions: Multiple prospective studies have shown benefits regarding cost and pain control for SP platform procedures compared to the traditional MP robotic approach. While its high cost and learning curve represent barriers to adoption, the SP platform represents a critical development in minimally invasive surgery. As this technology is further implemented at more institutions, long-term, high-quality data should accrue that will demonstrate its true value.

Upper Urinary Tract Surgery Through Robotic Single-Port System Vs Multiport and Laparoendoscopic Single-Site Systems: A Systematic Review and Meta-Analysis

Purpose: We aimed to make a general comparison between the safety and feasibility of a novel robotic platform, da Vinci^® single-port (SP) system with conventional robotic multiport (MP) and laparoendoscopic single-site systems (da Vinci Xi or Si) in three upper urinary tract procedures including robot-assisted partial nephrectomy (RAPN), robot-assisted pyeloplasty (RAP), and robot-assisted adrenalectomy (RA). Materials and Methods: After systematical searching of the literature up to October 2022 in PubMed^®, Web of Science™, and the Cochrane Library and Scopus^® databases, we extracted and processed the data in eligible literature for operative time, warm ischemia time (WIT), morphine milligram equivalent (MME), postoperative complications, and positive surgical margins (PSMs). Results: A total of 752 patients who underwent robotic surgery for SP or MP from 11 articles were included in this meta-analysis. There was no statistically significant difference in operative time for either RAPN (standardized mean difference [SMD] -0.14, 95% confidence interval [CI] -0.30 to 0.03) or RA (SMD -0.51, 95% CI -1.08 to 0.06). However, for RAP, SP can save operation time (SMD -0.73, 95% CI -1.24 to -0.22). The introduction of SP did not increase complications to any degree, including total complication (risk ratio [RR] 0.89, 95% CI 0.52-1.53), minor complication (RR 0.43, 95% CI 0.13-1.36), and major complication (RR 0.85, 95% CI 0.34-2.09), nor the incidence of PSMs (RR 1.04, 95% CI 0.54-1.99). It is worth noting that although the SP system increased WIT (SMD 0.44, 95% CI 0.26-0.62), it had the benefit of reducing intraoperative pain for RAPN with regard of MME (SMD -0.40, 95% CI -0.71 to -0.09). Conclusions: In terms of postoperative pain, SP robotic surgery is beneficial for RAPN but will make WIT prolonged. RAP is probably the most suitable upper urinary tract procedure for which SP is an option, which helps to shorten the surgery time and achieve a minimally invasive wound at the same time. Our study has been registered in PROSPERO (Registration No.: CRD42022350317).

Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay

Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.

Recent Advances in the Management of Localized and Locally Advanced Renal Cell Carcinoma: A Narrative Review

Purpose

To review the current status of surgical and procedural treatments for renal cell carcinoma (RCC), focusing on oncological and functional outcomes, and the use of techniques for advanced disease over the last 10 years.

Findings

Partial nephrectomy (PN) has become the reference standard for most T1 and T2 masses. In cT2 RCC, PN exhibits oncological equivalence and improved functional outcomes compared to radical nephrectomy (RN). Additionally, emerging data suggest that PN may be used to treat cT3a RCC. The robot-assisted platform is increasingly used to treat locally advanced RCC. Studies suggest safety and feasibility of robotic RN and robotic inferior vena cava tumor thrombectomy. Additionally, single-port robot-assisted laparoscopic approaches are comparable to multiport approaches in select patients. Long-term data show that cryoablation, radiofrequency ablation, and microwave ablation are equipotent in management of small renal masses. Emerging data suggest that microwave may effectively treat cT1b masses.

Comparison of Perioperative Outcomes Between Retroperitoneal Single-Port and Multiport Robot-Assisted Partial Nephrectomies

Objective: To report early institutional experience with the single-port robotic platform and compare perioperative outcomes between single-port robot-assisted partial nephrectomies (SP-RAPN) and multiport robot-assisted partial nephrectomies (MP-RAPN) when utilizing a retroperitoneal approach. Methods: A retrospective chart review of patients who underwent SP-RAPN or MP-RAPN at our institution between November 1, 2013 and May 30, 2021 was performed. Surgical platforms were compared through univariate analysis using the Kruskal-Wallis test for continuous variables and χ² test for categorical variables. Results: A total of 20 SP-RAPN and 42 MP-RAPN were performed utilizing a retroperitoneal approach. Patients who underwent SP-RAPN were more likely to have a lower radius, endophytic/exophytic, nearness, anterior/posterior, location score (4 vs 6; p = 0.0084) and their masses tended to be more exophytic, although this was not statistically significant (p = 0.0535). Patients undergoing SP-RAPN had a shorter postoperative length of hospital stay (1 vs 2 days; p < 0.0001). There were no significant differences in operative time, estimated blood loss, ischemia time, positive margin rate, malignant histology, postoperative complication rate, or Clavien-Dindo complication grade. Conclusion: Retroperitoneal SP-RAPN appear to be safe without compromising perioperative outcomes when compared with MP-RAPN for low-complexity renal masses. Further studies are recommended to assess the role of the SP for higher-complexity renal masses and to characterize variables that influence the observed difference in length of hospital stay.