Defining standards for retroperitoneal single-port (SP) robotic surgery: the Advancing Retroperitoneal International SP Excellence (ARISE) international Delphi consensus.

Abstract

To develop an international consensus on technical principles, training requirements, patient selection, and procedural best practices for retroperitoneal single-port (SP) robotic urological surgery through a structured Delphi methodology. A five-step modified Delphi process was conducted in accordance with ACcurate COnsensus Reporting Document (ACCORD) guidelines. A total of 32 statements were formulated by a steering committee of expert robotic surgeons and distributed to an international panel of 16 urologists from five countries. Consensus was defined as ≥70% agreement with <15% disagreement using a 9-point Likert scale. Statements without consensus after the first round were discussed, revised, and re-voted during an in-person meeting (Naples, Italy, July 2025). Internal reliability was evaluated with Cronbach's α, and inter-rater concordance with Kendall's W. A total of 14 experts participated in Round I and 12 in Round II. Consensus was achieved for 22 of 32 statements (69%), primarily addressing general principles, surgeon training, patient selection, access techniques, and perioperative management. Agreement was highest for the need for structured and proctored training (92.9%), suitability of low-complexity renal tumours as index cases (78.6%), and feasibility of the lower anterior access to enhance recovery (84%). No consensus was reached on absolute contraindications, specimen extraction protocols, or standardised criteria for platform selection in obese patients. Reliability of expert ratings was excellent across rounds (Cronbach's α = 0.98 and 0.92). This Delphi study provides the first international consensus defining principles and technical considerations for retroperitoneal SP robotic surgery. These consensus recommendations represent a key step toward standardisation and safer clinical adoption of SP retroperitoneal surgery, while highlighting areas needing further evidence.