Single-Port robot assisted partial nephrectomy: initial experience and technique with the da Vinci Single-Port platform (IDEAL Phase 1)

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.

Adrenalectomy Performed with the Da Vinci Single-Port Robotic System: A Systematic Review and Pooled Analysis

INTRODUCTION

The Da Vinci Single-Port (DV-SP) system emerged in 2018 but there is limited evidence on its use and perioperative outcomes for robot-assisted adrenalectomy (RAA).

METHODS

A systematic search was performed through PubMed, Scopus, Ovid, and WoS in December 2024. A PICO framework was used.

POPULATION

adult patients with adrenal masses; Intervention: DV-SP RAA; Outcomes: feasibility, reproducibility and safety of DV-SP RAA. A total of five retrospective studies involving 342 patients were included. The quantitative analysis was conducted using a random-effect model or a fixed-effect model as appropriate. A risk of bias assessment for non-randomized comparative studies and case series was performed.

RESULTS

The pooled mean operative time was 92.5 min (95% confidence interval [CI] 71.2, 113.9, p I2 = 0%, four studies), and the mean estimated blood loss (EBL) was 26.5 mL (95%CI -8.1, 61.2, I2 = 98.2%, three studies). Most of the procedures were completed with a single incision, though some required additional port placement, with a proportion of 9% (95%CI 0, 29, I2 = 71.7%, five studies). Perioperative complications were rare (0%, 95% CI 0, 4, I2 = 0%, five studies). Two studies comparing DV-SP and DV multi-port (MP) found no significant differences in complications. One study compared DV-SP RAA to DV Si or Xi single-access procedures. DV-SP showed improved operative techniques and better cosmetic outcomes. Limitations of this study are small sample size and potential selection bias due to smaller masses in the DV-SP RAA group.

CONCLUSIONS

DV-SP RAA is a promising approach, offering reduced operative time, low EBL, and excellent cosmetic results. This study shows that DV-SP RAA seems reproducible, feasible, and safe. Limitation of the included studies are small sample size and selection bias, which limits the generalizability of the results. Randomized comparative studies between DV-SP and MP RAA are needed to further validate these findings.

Advances in Robotic Surgery: In Favor of the Single Port Platform

Robotic single-port surgery represents the latest advance in the field of urology. Its benefits extend beyond enhanced cosmetic outcomes and offer a wide range of advantages for both patients and clinicians.

A Single Port (SP) Approach Reduces the Risk of Postoperative Complications in Elderly Patients Undergoing Robotic-Assisted Partial Nephrectomy (RAPN)

INTRODUCTION

In recent years, due to the increasing life expectancy and the growing popularity of nephron sparing strategies (NSS), more elderly and frail patients are undergoing Robotic-Assisted Partial Nephrectomy (RAPN) for the treatment of localized Renal Cell Carcinoma (RCC). A Single Port Approach has demonstrated itself to reduce estimated blood loss (EBL), complication rates, and length of stay (LOS). In the present study, we aim to compare perioperative and postoperative outcomes of SP RAPN and Multi Port (MP) RAPN, with a focus on elderly patients.

MATERIALS AND METHODS

In the study, 293 cN0M0 RCC patients who underwent MP and SP RAPN performed at our institution from 2018 to 2024 were retrospectively reviewed. Clinical, demographic, patient, and tumor characteristics and perioperative variables were assessed across group A (<65 years old) and group B (≥65 years old) patients, as well as MP and SP cohorts. Subsequently, univariate and multivariate regression analyses were carried out, particularly for elderly patients, to evaluate the impact of selected preoperative and perioperative variables on the risk of 30-day postoperative complications.

RESULTS

Clinical and demographic characteristics were similar across the MP and SP cohorts of group A and group B. The SP cohort of both group A and group B demonstrated significantly higher rates of extraperitoneal access (75.9% vs. 26.6% for group A, p < 0.001 and 81.8% vs. 26.2% for group B, p < 0.001), shorter median operative times (186 [142.8-222] min vs. 190 [153-238] min for group A, p < 0.001 and 173.5 [143-228] min vs. 206 [178-237] min for group B, p < 0.001), and shorter median LOS (0 [0-1] days vs. 2 [1-3] days for group A, p < 0.001 and 0 [0,1] days vs. 2 [2-4] days for group B, p < 0.001). Moreover, for both groups, an SP approach required significantly longer median ischemia times (21 min [18-31] vs. 20 min [16-24] for group A, p = 0.02 and 24.5 min [20-28] vs. 19.5 min [16-26] for group B, p = 0.03). However, the SP cohort of group B, despite the lower rate of on-clamp procedures (63.4% vs. 90.5%, p = 0.03), demonstrated significantly lower median EBL (50 mL [31-142] vs. 100 mL [50-200], p = 0.03). At multivariate analysis, the SP approach was an independent predictor of lower 30-day postoperative complications (OR: 0.2, 95%CI 0.04-0.9, p = 0.04).

CONCLUSIONS

In the present study, elderly patients undergoing SP RAPN did not demonstrate higher complication rates, EBL or hospitalization days compared to their younger counterparts. Moreover, an SP approach was found protective for 30-day postoperative complications. Our results suggest that SP RAPN is feasible and safe in older and frailer patients.

Fabrication and application of continuous douche for Da Vinci surgical robot arm

BACKGROUND

The use of robotic surgery in hospitals is becoming increasingly widespread.

OBJECTIVE

This research was performed to design a continuous douche for surgical robotic arm operated instruments and evaluate its use.

METHODS

A continuous irrigator was designed for robotic arm operated surgical instruments. A total of 240 recovered robotic-arm instruments were selected from the Disinfection Supply Center of our hospital. These were divided into two groups according to their recycling order, with single number instruments in the control group and even number instruments in the experimental group. Each group included 120 pieces. In the experimental group, continuous douching was used for perfusion and soaking, while control group instruments were infused and soaked using a 50 mL syringe. Data on cleaning quality, accuracy of perfusion tool injection volume, incidence of liquid reverse osmosis during injection and washing, and product satisfaction were collected for both groups.

RESULTS

The qualified manipulator cleaning rate and satisfaction with perfusion tools were higher in the experimental group than in the control group, and incidence of liquid reverse osmosis was lower in the experimental group than in the control group.

CONCLUSIONS

The self-made continuous perfusion device improved the instrument cleaning efficacy of the robotic surgical arm, accuracy of injection volume, and product satisfaction.

Partial nephrectomy series using Versius robotic surgical system: technique and outcomes of an initial experience

Partial nephrectomy (PN) represents a procedure where the use of a robot has further enabled successful completion of this complex surgery. The results of this procedure using Versius Robotic Surgical System (VRSS) still need to be evaluated. Our working group described the technique and reported the initial results of a series of PN using VRSS. We presented our setting, surgical technique and outcomes for PN, using VRSS. Between 2022 and 2023, 15 patients underwent PN performed by two surgeons in two different centers. Fifteen patients underwent PN. The median lesion size identified on preoperative imaging was 4 (IQR 2.3-5) cm. Median PADUA score was 8 (IQR 7-9). Two procedures were converted to radical nephrectomy for enhanced oncological disease control. Of the 13 nephrectomies that were completed as partial, 7 were performed clampless and 6 with warm ischemia clamping. Median clamping time was 10 (IQR 9-11) minutes. No procedure was converted to open. Median blood loss was 200 (IQR 100-250) mL. Median total operative time was 105 (IQR 100-110) minutes. Median console time was 75 (IQR 66-80) minutes. Median set-up time was 13 (IQR 12-14) minutes. No intraoperative complications were reported. The median hospitalization time was 4 (IQR 3.5-4) days. None of the patients were transfused and none of the patients required readmission. In a pathology report, one patient had a positive surgical margin. Our initial experience suggests that performing PN using VRSS is feasible with good short-term outcomes.

Clinical status and future prospects of single-incision robotic-assisted surgery: a review

Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic techniques. Cosmetic superiority, recovery benefits, and noninferior surgical outcomes weigh single-incision laparoscopic surgery as a promising modality. Although there are surgical challenges posed by steep learning curve and technological difficulties, such as instruments collision, triangulation loss and limited retraction, the establishment of robotic surgical platform as a solution to all is inspiring. Furthermore, with enhanced instrument maneuverability and stability, robotic ergonomic innovations adopt the advantages of single-incision laparoscopic surgery and surmount its recognized barriers by introducing a novel combination, single-incision robotic-assisted surgery. As was gradually diffused in general surgery and other specialties, single-incision robotic-assisted surgery manifests privileges in noninferior clinical outcomes an satisfactory cosmetic effect among strictly selected patients, and has the potential of a preferable surgical option for minimally invasive surgery.

Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023

Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).

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.

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.

A Propensity-Matched Comparison of the Perioperative Outcomes Between Single-Port and Multi-Port Robotic Assisted Partial Nephrectomy: A Report from the Single Port Advanced Research Consortium (SPARC)

Purpose: Single-port (SP) robotic surgery is a new technology and early in its adoption curve. The goal of this study is to compare the perioperative outcomes of SP to multi-port (MP) robotic technology for partial nephrectomy. Materials and Methods: This is a prospective cohort study of patients who have undergone robot-assisted partial nephrectomy using SP and MP technology. Baseline demographic, clinical, and tumor-specific characteristics and perioperative outcomes were compared using χ², t-test, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics. Results: After propensity matching, 146 SP patients were matched with 146 MP patients. SP and MP groups had similar mean age (58 ± 12 years vs 59 ± 12 years; p = 0.606) and proportion of men (54.11% vs 52.05%; p = 0.725). The SP had a longer mean ischemia (18.29 ± 10.49 minutes vs 13.79 ± 6.29 minutes; p < 0.001). Estimated blood loss (EBL) and length of hospital stay (LOS), operative time, positive margin rate, and any complication rate were similar between the two groups. Conclusions: SP partial nephrectomy had a longer ischemia time, and a comparable LOS, EBL, operative time, positive margin rates, and complication rates to MP. These early data are encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared with the standard MP technique.

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.

Single-port robotic surgery for mediastinal tumors using the da vinci SP system: Initial experience

PURPOSE

Studies of single-port robot-assisted thoracic surgery (RATS) using the da Vinci SP system, which uses a smaller surgical incision than the conventional multiport robot, have yet to be reported because of its smaller operating range. We report our initial experience using the da Vinci SP system in thoracic surgery for the resection of mediastinal tumors that requires a smaller workspace.

DESCRIPTION

Two patients diagnosed with superior mediastinal tumors underwent RATS performed with the da Vinci SP surgical system in January 2022. We used three-dimensional reconstruction to preoperatively determine the surgical incision. This is the first report of single-port RATS using the SP system in China.

EVALUATION

R0 resection was achieved in both operations without complications. Operation times and bleeding volumes were similar to the use of multiport RATS. No perioperative complications occurred.

CONCLUSIONS

The da Vinci SP system can be used for the resection of superior mediastinal tumors. Case selection and preoperative planning should be performed prior to these surgeries.