Comparison of Single- and Multiport Robot-assisted Approaches in Prostate and Renal Surgery: A Systematic Review and Meta-analysis.

Abstract

The aim of this systematic review with meta-analysis was to assess the perioperative, functional, and oncological outcomes of single-port (SP) robotic procedures in the surgical management of prostate and renal diseases. A systematic review was conducted using the MEDLINE and Scopus databases, covering literature published up to December 2024. Studies were included if these compared SP versus multiport (MP) approaches in robot-assisted procedures, specifically radical prostatectomy (RARP), simple prostatectomy (RASP), partial nephrectomy (RAPN), radical nephrectomy (RARN), and pyeloplasty (RAP; PROSPERO registration number: CRD42025616519). Perioperative outcomes were assessed across all procedures. Functional and oncological outcomes were analysed specifically in patients undergoing RARP, while warm ischaemia time (WIT), off-clamp rates, and positive surgical margin rates were evaluated in those undergoing RAPN. A total of 26, three, nine, one, and two studies evaluated RARP, RASP, RAPN, RARN, and RAP, respectively. Compared with MP-RARP, SP-RARP was associated with lower estimated blood loss (standardised mean difference [SMD] = 0.51; 95% confidence interval [CI]: 0.16-0.87), shorter length of stay (SMD = 1.12; 95% CI: 0.63-1.62), and reduced postoperative pain (SMD = 0.12; 95% CI: 0.04-0.35). The only difference between SP- and MP-RASP was represented by the use of a higher morphine milligram equivalent in the MP group (SMD = 0.59; 95% CI: 0.01-1.16). In patients undergoing RAPN, SP was associated with a significantly higher WIT than MP (SMD = -0.32; 95% CI: -0.58 to -0.06). However, the length of hospital stay (SMD = 0.31; 95% CI: 0.03-0.59) and pain score on postoperative day 1 (SMD = 0.22; 95% CI: 0.01-0.43) were significantly in favour of SP-RAPN. Limitations were the lack of randomised trials, and the across-study heterogeneity in surgical techniques and outcome definitions. Compared with the MP approach, SP robotic surgery offers advantages in terms of reduced postoperative pain and hospital stay. In patients undergoing RARP, functional and oncological outcomes were comparable between the two approaches. In patients undergoing RAPN, the SP approach was associated with a longer WIT.