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Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis

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Abstract

Objective

Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries.

Methods

A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis.

Results

There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = − 0.63, 95% Cl [− 1.06, − 0.21], P < 0.05), less estimated blood loss (WMD = − 19.56, 95% Cl [− 32.21, − 6.91], P < 0.05), less lymph node yields (WMD = − 3.35, 95% Cl [− 5.16, − 1.55], P < 0.05), less postoperative opioid use (WMD = − 5.86, 95% Cl [− 8.83, − 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate.

Conclusion

Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.

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References

  1. Huang MM, Patel HD, Wainger JJ, Su ZT, Becker REN, Han M, Pierorazio PM, Allaf ME (2021) Comparison of perioperative and pathologic outcomes between single-port and standard robot-assisted radical prostatectomy: an analysis of a high-volume center and the pooled world experience. Urology 147:223–229

    Article  PubMed  Google Scholar 

  2. Gettman MT, Hoznek A, Salomon L, Katz R, Borkowski T, Antiphon P, Lobontiu A, Abbou CC (2003) Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system. J Urol 170(2 Pt 1):416–419

    Article  PubMed  Google Scholar 

  3. Checcucci E, De Cillis S, Pecoraro A, Peretti D, Volpi G, Amparore D, Piramide F, Piana A, Manfredi M, Fiori C et al (2020) Single-port robot-assisted radical prostatectomy: a systematic review and pooled analysis of the preliminary experiences. BJU Int 126(1):55–64

    Article  PubMed  Google Scholar 

  4. Bertolo R, Garisto J, Gettman M, Kaouk J (2018) Novel system for robotic single-port surgery: feasibility and state of the art in urology. Eur Urol Focus 4(5):669–673

    Article  PubMed  Google Scholar 

  5. Billah MS, Stifelman M, Munver R, Tsui J, Lovallo G, Ahmed M (2020) Single port robotic assisted reconstructive urologic surgery-with the da Vinci SP surgical system. Transl Androl Urol 9(2):870–878

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kaouk J, Garisto J, Bertolo R (2019) Robotic urologic surgical interventions performed with the single port dedicated platform: first clinical investigation. Eur Urol 75(4):684–691

    Article  PubMed  Google Scholar 

  7. Lenfant L, Sawczyn G, Aminsharifi A, Kim S, Wilson CA, Beksac AT, Schwen Z, Kaouk J (2021) Pure single-site robot-assisted radical prostatectomy using single-port versus multiport robotic radical prostatectomy: a single-institution comparative study. Eur Urol Focus 7(5):964–972

    Article  PubMed  Google Scholar 

  8. Balasubramanian S, Ronstrom C, Shiang A, Vetter JM, Sheets J, Palka J, Figenshau RS, Kim EH (2022) Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy. World J Urol 41(1):35–41

  9. Hinojosa-Gonzalez DE, Roblesgil-Medrano A, Torres-Martinez M, Alanis-Garza C, Estrada-Mendizabal RJ, Gonzalez-Bonilla EA, Flores-Villalba E, Olvera-Posada D (2022) Single-port versus multiport robotic-assisted radical prostatectomy: a systematic review and meta-analysis on the da Vinci SP platform. Prostate 82(4):405–414

    Article  CAS  PubMed  Google Scholar 

  10. Li KP, Chen SY, Wang CY, Yang L (2022) Perioperative and oncologic outcomes of single-port versus conventional robotic-assisted partial nephrectomy: an evidence-based analysis of comparative outcomes. J Robot Surg 17(3):765–777

    Article  PubMed  Google Scholar 

  11. Kim JE, Kaldany A, Lichtbroun B, Singer EA, Jang TL, Ghodoussipour S, Kim MM, Kim IY (2022) Single-port robotic radical prostatectomy: short-term outcomes and learning curve. J Endourol 36(10):1285–1289

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lenfant L, Corrigan D, Beksac AT, Schwen Z, Kaouk J (2021) Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU Int 128(6):688–691

    Article  PubMed  Google Scholar 

  13. Talamini S, Halgrimson WR, Dobbs RW, Morana C, Crivellaro S (2021) Single port robotic radical prostatectomy versus multi-port robotic radical prostatectomy: a human factor analysis during the initial learning curve. Int J Med Robot 17(2):e2209

    Article  PubMed  Google Scholar 

  14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008

    Article  PubMed  PubMed Central  Google Scholar 

  16. Harrison R, Stifelman M, Billah M, Zaifman J, Lulla T, Sanchez De La Rosa R, Koster H, Lovallo G, Ahmed M (2022) Propensity-score matched analysis between extraperitoneal single port and intraperitoneal multiport radical prostatectomy: a single-institutional experience. Urology 165:198–205

    Article  PubMed  Google Scholar 

  17. Na JC, Alip S, Son NH, Kim J, Jang WS, Lee YS, Rha KH, Han WK (2021) A matched analysis of conventional multi-port versus SP single-site robotic partial nephrectomy. J Urol 206(SUPPL 3):e770

    Google Scholar 

  18. Noh TI, Kang YJ, Shim JS, Kang SH, Cheon J, Lee JG, Kang SG (2022) Single-port vs multiport robot-assisted radical prostatectomy: a propensity score matching comparative study. J Endourol 36(5):661–667

    Article  PubMed  Google Scholar 

  19. Shiang AL, Palka JK, Balasubramanian S, Figenshau RS, Smith ZL, Kim EH (2022) Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy. J Robot Surg 17(3):835–840

  20. Vigneswaran HT, Schwarzman LS, Francavilla S, Abern MR, Crivellaro S (2020) A comparison of perioperative outcomes between single-port and multiport robot-assisted laparoscopic prostatectomy. Eur Urol 77(6):671–674

    Article  PubMed  Google Scholar 

  21. Ganesan V, Steinberg RL, Garbens A, Trivedi H, Sorokin I, Roehrborn CA, Johnson BA, Gahan JC (2022) Single-port robotic-assisted simple prostatectomy is associated with decreased post-operative narcotic use in a propensity score matched analysis. J Robot Surg 16(2):295–300

    Article  PubMed  Google Scholar 

  22. Khalil MI, Chase A, Joseph JV, Ghazi A (2022) Standard multiport vs single-port robot-assisted simple prostatectomy: a single-center initial experience. J Endourol 36(8):1057–1062

    Article  PubMed  Google Scholar 

  23. Glaser ZA, Burns ZR, Fang AM, Saidian A, Magi-Galluzzi C, Nix JW, Rais-Bahrami S (2022) Single- versus multi-port robotic partial nephrectomy: a comparative analysis of perioperative outcomes and analgesic requirements. J Robot Surg 16(3):695–703

    Article  PubMed  Google Scholar 

  24. Harrison R, Ahmed M, Billah M, Sheckley F, Lulla T, Caviasco C, Sanders A, Lovallo G, Stifelman M (2022) Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes. J Robot Surg. https://doi.org/10.1007/s11701-022-01415-8

    Article  PubMed  Google Scholar 

  25. Okhawere KE, Beksac AT, Wilson MP, Korn TG, Meilika KN, Harrison R, Morgantini L, Ahmed M, Mehrazin R, Abaza R et al (2022) A propensity-matched comparison of the perioperative outcomes between single-port and multi-port robotic assisted partial nephrectomy: a report from the single port advanced research consortium (SPARC). J Endourol 36(12):1526–1531

    Article  PubMed  Google Scholar 

  26. Okhawere KE, Korn TG, Beksac AT, Patel RD, Wilson MP, Ranti D, Harrison R, Ahmed M, Mehrazin R, Abaza R et al (2021) Comparison of peri-operative outcomes of single port and multi-port robotic assisted partial nephrectomy: a multi-center study. J Urol 206(SUPPL 3):e1146–e1147

    Google Scholar 

  27. Palacios AR, Morgantini L, Trippel R, Crivellaro S, Abern MR (2022) Comparison of perioperative outcomes between retroperitoneal single-port and multiport robot-assisted partial nephrectomies. J Endourol 36(12):1545–1550

    Article  PubMed  Google Scholar 

  28. Ali D, Sawhney R, Billah M, Harrison R, Stifelman M, Lovallo G, Gopal N, Zaifman J, Ahsanuddin S, Lama-Tamang T et al (2022) Single-port robotic radical cystectomy with intracorporeal bowel diversion: initial experience and review of surgical outcomes. J Endourol 36(2):216–223

    Article  PubMed  Google Scholar 

  29. Gross JT, Vetter JM, Sands KG, Palka JK, Bhayani SB, Figenshau RS, Kim EH (2021) Initial experience with single-port robot-assisted radical cystectomy: comparison of perioperative outcomes between single-port and conventional multiport approaches. J Endourol 35(8):1177–1183

    Article  PubMed  Google Scholar 

  30. Xu D-L, Ju G-Q, Wang Z-J, Shi J-Z, Zhang Z-Q, Wu Z-J, Yin L, Liu B, Wang L-H (2021) A comparison of perioperative outcomes between extraperitoneal robotic single-port and multiport radical prostatectomy with the da Vinci Si Surgical System. Asian J Androl 23(6):640

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fujimura T (2019) Current status and future perspective of robot-assisted radical cystectomy for invasive bladder cancer. Int J Urol 26(11):1033–1042

    Article  PubMed  Google Scholar 

  32. Tyritzis SI, Collins JW, Wiklund NP (2018) The current status of robot-assisted cystectomy. Indian J Urol 34(2):101–109

    Article  PubMed  PubMed Central  Google Scholar 

  33. Fagotti A, Bottoni C, Vizzielli G, Gueli Alletti S, Scambia G, Marana E, Fanfani F (2011) Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril 96(1):255-259.e252

    Article  PubMed  Google Scholar 

  34. Kliethermes C, Blazek K, Ali K, Nijjar JB, Kliethermes S, Guan X (2017) Postoperative Pain After Single-Site Versus Multiport Hysterectomy. Jsls 21(4):e2017.00065

    Article  PubMed  PubMed Central  Google Scholar 

  35. Garbens A, Morgan T, Cadeddu JA (2021) Single port robotic surgery in urology. Curr Urol Rep 22(4):22

    Article  PubMed  Google Scholar 

  36. Kaku K, Okabe Y, Sato Y, Hisadome Y, Mei T, Noguchi H, Nakamura M (2021) Predicting operation time and creating a difficulty scoring system in donor nephrectomy. J Endourol 35(11):1623–1630

    Article  PubMed  Google Scholar 

  37. Bertolo R, Garisto J, Bove P, Mottrie A, Rocco B, Science EAURUSWGo (2021) Perioperative outcomes between single-port and “multi-port” robotic assisted radical prostatectomy: where do we stand? Urology 155:138–143

    Article  PubMed  Google Scholar 

  38. Abaza R, Murphy C, Bsatee A, Brown DH Jr, Martinez O (2021) Single-port robotic surgery allows same-day discharge in majority of cases. Urology 148:159–165

    Article  PubMed  Google Scholar 

  39. Wilson CA, Aminsharifi A, Sawczyn G, Garisto JD, Yau R, Eltemamy M, Kim S, Lenfant L, Kaouk J (2020) Outpatient extraperitoneal single-port robotic radical prostatectomy. Urology 144:142–146

    Article  PubMed  Google Scholar 

  40. Bertolo R, Garisto J, Bove P, Mottrie A, Rocco B (2021) Perioperative outcomes between single-port and “multi-port” robotic assisted radical prostatectomy: where do we stand? Urology 155:138–143

    Article  PubMed  Google Scholar 

  41. Martinez O, Murphy C, Bsatee A, Brown Dh Jr, Abaza R (2021) Impact of surgeon-controlled suction during robotic prostatectomy to reduce dependence on bedside assistance. J Endourol 35(8):1163–1167

    Article  PubMed  Google Scholar 

  42. Hingu J, Corse T, Zaifman J, De La Rosa RS, Khan BA, Alter K, Sheckley F, Sorin S, Lovallo G, Munver R et al (2022) Comparison of intermediate outcomes of single port and multiport robotic assisted partial nephrectomy. J Urol 207(SUPPL 5):e957–e958

    Google Scholar 

  43. Seyedin SN, Mitchell DL, Mott SL, Russo JK, Tracy CR, Snow AN, Parkhurst JR, Smith MC, Buatti JM, Watkins JM (2019) Is more always better? An assessment of the impact of lymph node yield on outcome for clinically localized prostate cancer with low/intermediate risk pathology (pT2-3a/pN0) managed with prostatectomy alone. Pathol Oncol Res 25(1):209–215

    Article  PubMed  Google Scholar 

  44. Malkoç E, Maurice MJ, Kara Ö, Ramirez D, Nelson RJ, Dagenais J, Fareed K, Fergany A, Stein RJ, Mouracade P et al (2019) Predictors of positive surgical margins in patients undergoing partial nephrectomy: a large single-center experience. Turk J Urol 45(1):17–21

    Article  PubMed  PubMed Central  Google Scholar 

  45. Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM (2013) Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥ 1 year of follow-up. Eur Urol 64(6):974–980

    Article  PubMed  Google Scholar 

  46. Kurz A, Sessler DI (2003) Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs 63(7):649–671

    Article  CAS  PubMed  Google Scholar 

  47. Wallström A, Frisman GH (2014) Facilitating early recovery of bowel motility after colorectal surgery: a systematic review. J Clin Nurs 23(1–2):24–44

    Article  PubMed  Google Scholar 

  48. Lenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J (2021) Single-institution cost comparison: single-port versus multiport robotic prostatectomy. Eur Urol Focus 7(3):532–536

    Article  PubMed  Google Scholar 

  49. Patel BG, Biebel MG, Venkatesh R, Figenshau S (2022) Single port robotic urologic surgery: fewer ports, higher costs. J Endourol 36:A251

    Google Scholar 

  50. Kang SK, Jang WS, Kim SH, Kim SW, Han SW, Lee YS (2021) Comparison of intraoperative and short-term postoperative outcomes between robot-assisted laparoscopic multi-port pyeloplasty using the da Vinci Si system and single-port pyeloplasty using the da Vinci SP system in children. Investig Clin Urol 62(5):592–599

    Article  PubMed  PubMed Central  Google Scholar 

  51. Wells G, Shea B, O’Connell D et al (2021) The NewcastleOttawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Available from: https://www.ohri.ca//programs/clinical_epidemiology/oxford.asp

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Funding

The research was supported by the Sichuan Province Science and Technology Planning Project (Grant 2020YFS0320).

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Author notes

  1. Si Ge and Zhiqiang Zeng have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China

    Si Ge, Yunxiang Li, Lijian Gan, Kangsen Li, Zuoping Wang & Lei Zheng

  2. Department of UrologySchool of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China

    Si Ge, Zhiqiang Zeng, Yunxiang Li & Chunyang Meng

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  1. Si Ge
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Correspondence to Yunxiang Li.

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Ge, S., Zeng, Z., Li, Y. et al. Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis. World J Urol 42, 18 (2024). https://doi.org/10.1007/s00345-023-04711-6

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