Safety and short-term outcomes during the introduction of retroperitoneal single-port robot-assisted radical prostatectomy: a single-surgeon comparison with transperitoneal multiport radical prostatectomy in a Japanese population.

To evaluate the safety and feasibility of introducing retroperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) by comparing a single surgeon's initial 50 cases with 50 recent transperitoneal multiport RARP (MP-RARP) cases in a Japanese population. Consecutive non-pelvic-lymph-node-dissection RARP performed by one surgeon between December 2022 and January 2026 (50 retroperitoneal SP-RARP, 50 transperitoneal MP-RARP) were analyzed retrospectively using the Mann-Whitney U and Fisher exact tests. Age, body mass index, initial prostate-specific antigen, clinical T stage and nerve-sparing rate were comparable, but high-grade biopsy disease (grade group ≥ 3) was more frequent with SP (50% vs. 28%; P = 0.040). Operative time was 143 vs. 152 min (P = 0.055). There were no transfusions and no Clavien-Dindo grade ≥ II complications or anastomotic leaks. Rescue analgesic doses were fewer with SP (median 0 vs. 1; P = 0.011). Three-month social continence (76.0% vs. 78.0%; P = 1.00) and the positive surgical margin rate (14.0% vs. 24.0%; P = 0.31) did not differ. Length of stay was unchanged (median 9 days). During its introduction phase, the extraperitoneal SP approach was performed safely, with a significantly lower analgesic requirement; margin status and 3-month continence did not differ significantly. Larger studies with longer follow-up are required.