Comparative outcomes of multi-port versus single-port robotic-assisted partial nephrectomy with same-day discharge: impact of surgical approach.

Abstract

Same-day discharge robotic-assisted partial nephrectomy (SDS-RAPN) is increasingly adopted due to emerging evidence supporting its safety and feasibility. However, comparative data evaluating perioperative, renal, and oncologic outcomes between multi-port (MP) and single-port (SP) robotic platforms, particularly across extraperitoneal and transperitoneal surgical approaches, remain limited. We sought to evaluate and compare these outcomes in patients undergoing SDS-RAPN. We retrospectively analyzed 70 consecutive SDS-RAPN procedures performed by a single surgeon at our institution. Patients were stratified by robotic platform (MP vs. SP), with a secondary sub-analysis comparing extraperitoneal and transperitoneal approaches. Outcomes included perioperative parameters, renal function, oncologic outcomes, complications, and readmissions. MP-RPN was associated with longer follow-up (516 vs. 22 days, p = 0.001). At discharge, serum creatinine levels were lower in SP patients (0.84 vs. 0.99 mg/dL; p = 0.04),but similar at last follow-up (p = 0.14). The SP cohort more frequently had lower pole tumors (59% vs. 28%, p = 0.008). Extraperitoneal access was more common in SP (65% vs. 46%), while transperitoneal access was predominant in MP (54% vs. 35%, p = 0.02). No significant differences were observed in ischemia time, operative time, or complication rates. No readmissions or mortality occurred within 90 days. SDS-RAPN is feasible, safe, and effective using either MP or SP robotic systems, with comparable short-term outcomes and no increase in complications or readmissions. Surgical platform and approach choice should be individualized, considering tumor characteristics and patient anatomy. Prospective studies are needed to validate our analysis.