Evidence and outcomes

What pooled studies report today, and what is not yet proven. Last reviewed 22 April 2026.

What the evidence shows

The evidence base for SP robotic surgery is newer and smaller than the evidence base for multiport RARP, but has grown rapidly since 2020. There are no randomised trials to date; the evidence consists of matched and unmatched comparative cohorts and several recent systematic reviews with meta-analysis.

SP vs multiport radical prostatectomy (SP-RARP vs MP-RARP)

2025 systematic review and meta-analysis (Ficarra et al., European Urology 2025). 26 comparative studies of SP vs MP robotic radical prostatectomy. Compared with MP-RARP, SP-RARP was associated with:1

  • Lower estimated blood loss (standardised mean difference 0.51; 95% CI 0.16 to 0.87).
  • Shorter hospital length of stay (SMD 1.12; 95% CI 0.63 to 1.62).
  • Lower post-operative pain scores (SMD 0.12; 95% CI 0.04 to 0.35 - a small but consistent effect).
  • Comparable continence, potency, positive surgical margin and biochemical recurrence outcomes at the follow-up intervals reported.

2025 systematic review and meta-analysis (Franco et al., Prostate Cancer and Prostatic Diseases 2025). 21 SP studies (18 SP-RARP, 3 SP simple prostatectomy) and 8 comparative studies pooled for meta-analysis. Mean follow-up 8.1 +/- 5.8 months. Similar operative time, catheterisation time, complication rate, continence, potency, positive surgical margin and biochemical recurrence between SP and MP; hospital stay shorter for SP (weighted mean difference -0.58 days after sensitivity analysis).2

2022 meta-analysis (Li et al., Journal of Endourology). SP-RARP was associated with a shorter stay (-17.86 hours; 95% CI -27.80 to -7.92 h) and lower opioid requirement than MP-RARP, with comparable perioperative and oncological outcomes.4

Single-institution and multi-institutional comparative series. Kaouk's group at the Cleveland Clinic reported the first SP-RARP clinical experience using the commercialised SP1098 system in 2019, with a purpose-built extraperitoneal single-site technique described in 2020.5,6 Subsequent large comparisons (Vigneswaran 2020,15 Abaza 2021,8 Abou Zeinab 2023 multi-institutional16) have reported comparable operative times and margin rates once past the early learning curve.

SP for kidney surgery

The same 2025 meta-analysis analysed 9 SP vs MP studies for partial nephrectomy. SP was associated with a shorter hospital stay (SMD 0.31; 95% CI 0.03 to 0.59) and lower day-1 pain scores (SMD 0.22; 95% CI 0.01 to 0.43), but a longer warm ischaemia time (SMD -0.32; 95% CI -0.58 to -0.06).1 Warm ischaemia time reflects how long the blood supply to the kidney is interrupted during tumour excision, and shorter is generally better; a 2024 dedicated SP vs MP partial-nephrectomy meta-analysis (Nguyen et al., 2,689 patients across 15 studies) confirmed the small clamp-time difference but found no measurable difference in post-operative kidney function (eGFR) or margins.9

SP radical nephrectomy is feasible in published case series, but comparative evidence is very limited - only one comparative study was eligible for the renal sub-analysis in Ficarra 2025.1

SP pyeloplasty has a small but growing evidence base, including the first dedicated series by Lenfant et al. 202017 and a non-narcotic, same-day-discharge pathway established at the Cleveland Clinic (Beksac et al. 2022).18

Where the evidence is not yet definitive

  • There are no randomised trials comparing SP and MP for any urological indication.1,2
  • Long-term cancer outcomes (biochemical recurrence beyond five years, cancer-specific survival) are not yet available for SP-RARP at the same follow-up depth as for MP-RARP; mean follow-up across the 2025 Franco meta-analysis was 8.1 +/- 5.8 months.2
  • Cost analyses vary by institution; SP has been reported as cost-comparable to MP in at least one US single-institution study (US$13,512 vs US$13,284, p = 0.32).10
  • Neither the 2025 EAU Prostate Cancer Guidelines nor the 2022/2024 AUA/SUO Clinically Localised Prostate Cancer Guidelines make any distinction between the SP and MP robotic platforms. There is currently no published USANZ position statement specific to single-port robotic surgery.19,20

Patients should know that the reasons SP is being offered are primarily fewer incisions, access from outside the peritoneum, shorter hospital stay and lower post-operative pain, with oncological and functional outcomes that the current evidence shows to be comparable to the well-established multiport robotic approach.1,2

References
  1. Ficarra V, Romito I, Sorce G, Maravigna D, De Stefano A, Mottrie A, Abdollah F, Vigano S, Stabile A, Salonia A, Giannarini G, Crocerossa F, Gandaglia G, Montorsi F, Rossanese M. Comparison of Single- and Multiport Robot-assisted Approaches in Prostate and Renal Surgery: A Systematic Review and Meta-analysis. European Urology. 2025;88(6):589-613. doi:10.1016/j.eururo.2025.08.010. PubMed PMID: 41016915.
  2. Franco A, Ditonno F, Manfredi C, Pellegrino AA, Licari LC, Bologna E, Feng C, Antonelli A, De Sio M, De Nunzio C, Porpiglia F, Cherullo EE, Kaouk J, Crivellaro S, Autorino R. Single port robot-assisted radical and simple prostatectomy: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases. 2025;28(1):117-128. doi:10.1038/s41391-024-00787-2. PubMed PMID: 38263281.
  3. Nguyen TT, Basilius J, Ali SN, Dobbs RW, Lee DI. Single-Port Robotic Applications in Urology. Journal of Endourology. 2023;37(6):688-699. doi:10.1089/end.2022.0600. PubMed PMID: 36924293.
  4. Li K, Yu X, Yang X, Huang J, Deng X, Su Z, Wang C, Wu T. Perioperative and Oncologic Outcomes of Single-Port vs Multiport Robot-Assisted Radical Prostatectomy: A Meta-Analysis. Journal of Endourology. 2022;36(1):83-98. doi:10.1089/end.2021.0210. PubMed PMID: 34157849.
  5. Kaouk J, Bertolo R, Eltemamy M, Garisto J. Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP Surgical System. Urology. 2019;124:309. doi:10.1016/j.urology.2018.10.025. PubMed PMID: 30367924.
  6. Kaouk J, Valero R, Sawczyn G, Garisto J. Extraperitoneal single-port robot-assisted radical prostatectomy: initial experience and description of technique. BJU International. 2020;125(1):182-189. doi:10.1111/bju.14885.
  7. Kaouk J, Aminsharifi A, Sawczyn G, Kim S, Wilson CA, Garisto J, Fareed K. Single-Port Robotic Urological Surgery Using Purpose-Built Single-Port Surgical System: Single-Institutional Experience With the First 100 Cases. Urology. 2020;140:77-84. doi:10.1016/j.urology.2019.11.086. PubMed PMID: 32142725.
  8. Abaza R, Martinez O, Murphy C, et al. Single-port Robotic Surgery Allows Same-day Discharge in Majority of Cases. Urology. 2021;148:159-165. doi:10.1016/j.urology.2020.08.092.
  9. Nguyen TT, Ngo XT, Duong NX, Dobbs RW, Vuong HG, Nguyen DD, Basilius J, Onder NK, Mendiola DFA, Hoang TD, Pham DNM, Nguyen A, Thi TMT, Naushad AS, Shahait M, Lee DI. Single-Port vs Multiport Robot-Assisted Partial Nephrectomy: A Meta-Analysis. Journal of Endourology. 2024;38(3):253-261. doi:10.1089/end.2023.0505. PubMed PMID: 38185840.
  10. Lenfant L, Sawczyn G, Kim S, Aminsharifi A, Kaouk J. Single-institution Cost Comparison: Single-port Versus Multiport Robotic Prostatectomy. European Urology Focus. 2021;7(3):532-536. doi:10.1016/j.euf.2020.06.010. PubMed PMID: 32631777.
  11. US FDA. 510(k) Premarket Notification K173906 - da Vinci SP1098 Surgical System. Decision date 31 May 2018. FDA 510(k) document
  12. Intuitive Surgical. da Vinci SP System Brochure and Instruments & Accessories Catalog (document MAT09584, 09/2025).
  13. Soputro NA, Kaouk J. Single-port robot-assisted radical prostatectomy. World Journal of Urology. 2024;42:263. doi:10.1007/s00345-024-04914-5.
  14. Rich JM, Okhawere KE, Nguyen C, et al. Transperitoneal Versus Retroperitoneal Single-port Robotic-assisted Partial Nephrectomy: An Analysis from the Single Port Advanced Research Consortium. European Urology Focus. 2023;9(6):1059-1064. doi:10.1016/j.euf.2023.06.004. PubMed PMID: 37394396.
  15. Vigneswaran HT, Schwarzman LS, Francavilla S, Abern MR, Crivellaro S. A Comparison of Perioperative Outcomes Between Single-port and Multiport Robot-assisted Laparoscopic Prostatectomy. European Urology. 2020;77(6):671-674. doi:10.1016/j.eururo.2020.03.031.
  16. Abou Zeinab M, Beksac AT, Ferguson E, Kaviani A, Moschovas MC, Joseph J, Kim M, Crivellaro S, Nix J, Patel V, Kaouk J. Single-port Extraperitoneal and Transperitoneal Radical Prostatectomy: A Multi-Institutional Propensity-Score Matched Study. Urology. 2023;171:140-145. doi:10.1016/j.urology.2022.10.001. PubMed PMID: 36244472.
  17. Lenfant L, Wilson CA, Sawczyn G, Aminsharifi A, Kim S, Kaouk J. Single-port Robot-assisted Dismembered Pyeloplasty With Mini-Pfannenstiel or Peri-umbilical Access: Initial Experience in a Single Center. Urology. 2020;143:147-152. doi:10.1016/j.urology.2020.05.041. PubMed PMID: 32525047.
  18. Beksac AT, Wilson CA, Lenfant L, Kim S, Aminsharifi A, Zeinab MA, Kaouk J. Single-port Mini-Pfannenstiel Robotic Pyeloplasty: Establishing a Nonnarcotic Pathway Along With a Sameday Discharge Protocol. Urology. 2022;160:130-135. doi:10.1016/j.urology.2021.10.013. PubMed PMID: 34748830.
  19. Cornford P, Tilki D, van den Bergh RCN, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer, 2025 update. European Association of Urology.
  20. Sanda MG, et al. AUA/SUO Clinically Localized Prostate Cancer Guideline (2022, amended 2024). American Urological Association.
  21. Kaouk J, Haber GP, Autorino R, et al. A Novel Robotic System for Single-port Urologic Surgery: First Clinical Investigation. European Urology. 2014;66(6):1033-1043. doi:10.1016/j.eururo.2014.06.039. PubMed PMID: 25041850.
  22. Heo JE, Kang SK, Koh DH, Rha KH, Choi YD, Lee S. Outcomes of single-port robotic ureteral reconstruction using the da Vinci SP system. Investigative and Clinical Urology. 2023;64(4):373-379. doi:10.4111/icu.20230005. PubMed PMID: 37417562.
  23. Kaouk J, Beksac AT, Abou Zeinab M, Duncan A, Schwen ZR, Eltemamy M. Single Port Transvesical Robotic Radical Prostatectomy: Initial Clinical Experience and Description of Technique. Urology. 2021;155:130-137. doi:10.1016/j.urology.2021.05.022. PubMed PMID: 34038749.
  24. Huang MM, Patel HD, Wainger JJ, Su ZT, Becker REN, Pierorazio PM, Han M, Allaf ME. 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. 2021;147:223-229. doi:10.1016/j.urology.2020.08.046.
  25. Kaouk J, Schwen ZR, Beksac AT, Corrigan D, Lenfant L. Learning curve analysis of single-port robot-assisted extraperitoneal prostatectomy using the cumulative sum (CUSUM) method. BJU International. 2021;128(6):688-691. doi:10.1111/bju.15588.
  26. Biasatti A, Soputro NA, Porpiglia F, Perdona S, Abdollah F, Kaouk J, et al. The current landscape of single-port robotic surgery in urology. Nature Reviews Urology. 2026;23(3):156-173. doi:10.1038/s41585-025-01081-z.
  27. Wu J, Wang Y, Huang Y, Long X, Tang J, Gu D. Learning curve analysis of extraperitoneal single-site robotic-assisted radical prostatectomy: a CUSUM-based approach. Journal of Robotic Surgery. 2025;19(1):49. doi:10.1007/s11701-024-02202-3. PubMed PMID: 39792294.
  28. Nelson RJ. Presenter disclosures, American College of Osteopathic Surgeons 2022 Annual Clinical Assembly: proctoring other surgeons on the single port robotic platform. Disclosure record.
  29. Henry Ford Health. Congratulations to Dr Ryan Nelson - 500 urology cases using the da Vinci single-port system. October 2024.
  30. Zargar H (Western Urology). Single port robot, Melbourne (Epworth), from November 2025. Blog entry.
  31. Device Technologies Australia. St Vincent's becomes first hospital in NSW to install cutting-edge robotic-assisted surgery technology. Press release, January 2026.
  32. 7News. Da Vinci Single Port surgical robot transforms Australian operating theatres. 20 January 2026. 7news.com.au.

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