da Vinci® single-port versus da Vinci® Xi multiport robot-assisted radical prostatectomy for localized prostate cancer: a GRADE-assessed systematic review and meta-analysis.

BACKGROUND

The adoption of the da Vinci® single-port (SP) platform for robot-assisted radical prostatectomy (RARP) has expanded; however, comparative evidence versus the da Vinci® Xi multiport system remains heterogeneous across access corridors and perioperative pathways. We performed a GRADE-assessed systematic review and meta-analysis to quantify platform-level differences in oncologic surrogates, perioperative recovery, and early functional outcomes.

METHODS

This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420261299189). We systematically searched MEDLINE (via PubMed), Embase, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception to the final date of February 1, 2026. Eligible studies were comparative cohorts (prospective or retrospective, including propensity-matched designs) of adult patients with localized prostate cancer undergoing da Vinci® SP RARP compared directly with da Vinci® Xi multiport RARP. Studies were required to report at least one extractable perioperative, oncologic, or functional outcome measure. Outcomes were pooled using random effect models. The risk of bias was assessed using ROBINS-I, and the certainty of evidence was appraised using GRADE. No external funding was received for this study.

RESULTS

Five comparative cohorts were included, comprising 968 patients who underwent SP-RARP and 668 patients who underwent Xi or multiport RARP. The positive surgical margin rates were not significantly different between the approaches (RR 0.90, 95% CI 0.75-1.09; I²=0%). Operative time was longer with SP (MD 10.39 min, 95% CI 0.72-20.07; I²=88%), whereas estimated blood loss (MD - 68.95 mL, 95% CI - 128.27 to - 9.63; I²=98%) and length of hospital stay (MD - 17.01 h, 95% CI - 24.12 to - 9.89 h; I²=91%) favored SP. Lymph node dissection rates (RR 0.49, 95% CI 0.20-1.23; I²=99%), postoperative complications (RR 1.06, 95% CI 0.71-1.60; I²=0%), and urinary continence at ~ 3 months (RR 1.22, 95% CI 0.87-1.71; I²=92%) were not significantly different between the two groups. Corridor-based subgrouping did not modify the PSM effects (p for subgroup differences = 0.51). The certainty of evidence ranged from low to very low, limited by non-randomized designs and inconsistencies for several recovery endpoints.

CONCLUSIONS

Based on low-to very-low-certainty evidence from five nonrandomized cohorts, SP-RARP showed similar margin control and complication risk to Xi/multiport RARP, with a directional recovery signal favoring SP for blood loss and hospital stay; however, these estimates carried extreme heterogeneity (I²=98% and 91%) and should be regarded as exploratory. No strong platform-level recommendations can be made without prospective confirmatory evidence.