Single-Port Versus Multiport Robotic Colorectal Surgery: A Systematic Review and Meta-Analysis.

Abstract

Background: Single-port (SP) robotic surgery has emerged as a reduced-access alternative to conventional multiport (MP) robotic colorectal surgery. However, its comparative perioperative benefits remain uncertain. This systematic review and meta-analysis compared outcomes between SP and MP robotic colorectal surgery.

Methods: PubMed/MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were searched from inception through August 2026 for comparative studies evaluating SP versus MP robotic colorectal surgery. Odds ratios and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation.

Results: Ten comparative studies comprising 628 patients (SP, 288; MP, 340) were included, of whom 598 contributed to the pooled analyses. SP surgery was associated with shorter hospital stay (MD -0.9 days; 95% CI: -1.4 to -0.4; I² = 62.2%), shorter console time (MD: -39.6 minutes; 95% CI: -72.5 to -6.8; I² = 85.4%), and lower postoperative pain on postoperative day 1 (POD1, MD: -0.10 NRS points; 95% CI: -0.18 to -0.03; I² = 0%). No significant differences were observed in operative time, harvested lymph nodes, anastomotic leakage, postoperative ileus, or Clavien-Dindo grade ≥III complications. Sensitivity analyses suggested shorter operative time and lower estimated blood loss with SP surgery after exclusion of the studies contributing most to heterogeneity. Four studies had serious and six moderate overall risk of bias. Certainty of evidence was very low.

Conclusions: SP robotic colorectal surgery was associated with shorter hospital stay and console time and lower POD1 pain scores, without significant differences in operative time, major morbidity, or harvested lymph nodes in the primary analyses. Sensitivity analyses suggested potential additional operative benefits, but the observational evidence, heterogeneity, risk of bias, and very low certainty preclude conclusions of clinical superiority.