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

Abstract

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.