Probabilistic multi-criteria decision analysis comparing single-port and multiport robot-assisted radical prostatectomy and partial nephrectomy: A secondary analysis of systematic review data.

To compare single-port (SP) and multiport (MP) robot-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN) using probabilistic multi-criteria decision analysis (MCDA) integrating perioperative, functional, and oncological outcomes. A secondary analysis used meta-analytic data from Ficarra et al. (2025) comparing SP and MP across 26 RARP and 9 RAPN studies. Eleven criteria were evaluated for RARP and nine for RAPN. Effect estimates and 95% confidence intervals informed normal distributions for Monte Carlo simulation (50,000 iterations). Outcomes were mapped to a 0–1 scale using clinically interpretable anchors (± 1.5 for standardized mean difference; ± log[3] for log odds ratio). Five prespecified weighting scenarios (equal, safety, oncology, recovery, balanced) produced preference probabilities and net advantages with 95% credible intervals (CrI). Anchor perturbation assessed robustness. For RARP, SP showed higher preference probabilities across all scenarios (P[SP-RARP > MP-RARP] = 92.9% to > 99.9%), with the largest net advantage under recovery weights (0.128; 95% CrI: 0.081–0.172), driven by length of stay, catheterization time, and estimated blood loss. For RAPN, SP was preferred under recovery weights (P[SP-RAPN > MP-RAPN] = 97.5%; net advantage: 0.046; 95% CrI: 0.000–0.092) but attenuated under safety (62.1%) and oncology (63.7%) weights, where warm ischemia time and major complications penalized SP. Findings were stable across anchor perturbations. A structural sensitivity analysis excluding warm ischemia time (WIT) from the RAPN safety- and recovery-focused scenarios increased the SP preference probability in both RAPN scenarios; however, the safety-focused scenario retained substantial uncertainty (95% CrI crossing zero). SP-RARP demonstrates consistent probabilistic advantage regardless of priority weighting. For RAPN, SP advantage is scenario-dependent, with recovery benefit but considerable uncertainty under safety and oncology priorities. This framework provides transparent decision support, although conclusions remain contingent on the quality of underlying observational evidence.