Single-port Robotic Retroperitoneal Partial Nephrectomy via Low Anterior Access: A Propensity-matched Comparative Analysis to Standard Transperitoneal Multiport Robotic Surgery from the Single Port Advanced Research Consortium (SPARC).

BACKGROUND AND

OBJECTIVE

The introduction of the purpose-built single-port (SP) robotic platform has paved the way for the development of regionalized surgical approaches, as evident by the advent of low anterior access (LAA) SP retroperitoneal robot-assisted partial nephrectomy (rRAPN). Our aim was to evaluate perioperative outcomes of LAA SP-rRAPN in comparison to the standard transperitoneal multiport (MP) robotic approach.

METHODS

We performed a retrospective review of the institutional review board-approved, prospectively maintained database of the SP Advanced Research Consortium (SPARC) to identify all consecutive patients who underwent RAPN between 2015 and 2025. We applied 1:1 propensity score matching (PSM) for analysis to ensure comparable baseline characteristics, including comorbidities, renal function, and tumor complexity.

KEY FINDINGS AND LIMITATIONS: Of 2306 patients, our PSM analysis included 302 LAA SP-rRAPN cases and 302 MP-RAPN cases. Following PSM, the two cohorts demonstrated comparable operative time, estimated blood loss, surgical margin status, and incidence of major postoperative complications. A history of abdominal surgery was more common in the SP group (55.1% vs MP 42.7%; p = 0.005). Postoperatively, the SP cohort had significantly shorter hospital stay (<24 h: SP 41.6% vs MP 10.9%; p < 0.001), lower postoperative pain (median highest pain score: SP 5 vs MP 6; p < 0.001), and less frequent need for opioids (SP 46.3% vs MP 93.1%; p < 0.001). Notably, no SP patients experienced postoperative ileus or respiratory complications such as atelectasis, pleural effusion, or pneumonia.

CONCLUSIONS AND CLINICAL IMPLICATIONS: This study highlights the safety and efficacy of LAA SP-rRAPN, which has perioperative outcomes comparable to those for the transperitoneal MP robotic approach. Moreover, LAA SP-rRAPN offers additional benefits, including enhanced postoperative recovery with lower morbidity, and provides a viable surgical alternative for patients with complex abdominal surgical history.