Single-port versus multi-port robotic radical prostatectomy: a within-surgeon, propensity-matched analysis of platform-related effects.

To evaluate perioperative outcomes and characterize the early integration of single-port (SP) robot-assisted radical prostatectomy (RARP) in surgeons with established multi-port (MP) robotic experience. A prospectively maintained database of consecutive patients undergoing RARP between 2019 and 2025 was retrospectively analyzed. After excluding pelvic lymph node dissection cases and each surgeon’s initial MP learning curve, a propensity score–matched cohort (49 MP vs. 49 SP) was generated. The entire SP cohort (n = 98) was used to assess adoption dynamics through tertile stratification and LOESS modeling. Baseline characteristics were balanced. Perioperative outcomes were comparable, including length of stay, catheterization time, hemoglobin variation, and complication rates (all p > 0.1). Operative time was longer in the SP group (150 vs. 100 min; p < 0.001). Across sequential tertiles, operative time decreased (p = 0.04). LOESS analysis demonstrated a steep early decline within approximately the first 10–15 cases, followed by progressive stabilization, consistent with a short adaptation phase in proficient robotic surgeons. In experienced MP robotic surgeons, transition to SP-RARP preserved perioperative safety, with differences mainly confined to a transient increase in operative time. Rather than suggesting a distinct performance advantage over MP surgery, these findings define the early adaptation profile of SP integration within an already mature robotic program.