Single-Port Robotics
The da Vinci SP system delivers an articulating endoscope and three jointed instruments through a 25 mm cannula. This permits several access strategies, but the incision and operative corridor still depend on target distance, working space, prior surgery, assistant access and the surgeon's experience. Single-port access does not remove positioning, insufflation, bleeding or conversion risks.[1]
See Platforms & Manufacturers, Reconstructive Applications and Incisions & Closure.
Platform and Docking
SP instruments articulate at an elbow and wrist, enabling triangulation beyond the cannula. Current instruments and access kits differ from the earliest published configurations. Check the actual instrument, cannula, access kit and procedure labeling; “single port” in a paper may instead describe a multiport robot adapted to one incision.[1][2]
Floating docking raises the port/cannula away from the skin within a sealed access arrangement, increasing the available distance for instrument articulation when the target is close. It is not simply a synonym for docking into the bladder. The original supporting study was a dry-lab comparison; its working-distance measurements are not universal instructions for every later instrument or access kit.[3]
Incision and Corridor Options
| Option | Anatomical concept | Planning limitation |
|---|---|---|
| Periumbilical | Central access, commonly used for transperitoneal reconstruction | Scar concealment is one consideration; reach, adhesions and extraction requirements may favor another site. |
| Mini-Pfannenstiel / low transverse | Low transverse abdominal access described for selected pyeloplasties and pelvic operations | The skin incision alone does not identify the deep corridor. Published pyeloplasty experience included both this and midline access. |
| Midline suprapubic transvesical | Bladder access through a cystotomy, with pneumovesicum and a compatible sealed access system | Requires bladder entry/closure and careful insufflation management; not a no-risk substitute for pneumoperitoneum. |
| Low anterior access (LAA) | Anterior lower-quadrant entry that can support retroperitoneal or transperitoneal access in selected operations | Descriptions and landmarks vary between published techniques; do not merge all LAA and SARA protocols into one fixed incision recipe. |
| Supine anterior retroperitoneal access (SARA) | Supine access near McBurney's point or its left-sided counterpart, with development of a retroperitoneal workspace | Supine positioning avoids some lateral-position demands but does not eliminate pressure, nerve or other positioning injuries. |
| Posterior retroperitoneal | Direct access to the retroperitoneum, often in a lateral position | Remains a valid alternative; choice depends on target anatomy, access and expertise. |
| Extraperitoneal pelvic, without bladder entry | Access to pelvic extraperitoneal planes such as the space of Retzius | Distinct from transvesical access. Prior operations can affect either approach. |
These are access concepts, not stand-alone operative steps. For pyeloplasty, ureteral reconstruction and simple prostatectomy, use the relevant treatment atlas for selection and procedural detail.[4][5][6][7]
What the Evidence Supports
A 2025 systematic review of SP reconstructive urology found only six retrospective comparisons suitable for its pyeloplasty meta-analysis. It found no statistically clear difference in success, complications or operative time; cosmetic benefit was evaluated in only one included study. Other reconstructions were represented mainly by small series or case reports, and some “single-port” studies used adapted multiport systems. These findings support feasibility while leaving comparative and long-term benefit uncertain.[2]
Selected access studies help interpret the techniques, but should not become universal discharge or functional-recovery targets:
| Study / actual cohort | What was reported | Appropriate interpretation |
|---|---|---|
| Lenfant 2020: 10 pyeloplasties, six mini-Pfannenstiel and four midline | Mean operative time 166 minutes; median stay 21 hours; all met the study's three-month success definition | These are mixed-access initial results, not a periumbilical-only benchmark or proof of long-term equivalence.[4] |
| Pellegrino 2023 SARA: 18 operations, including 12 partial nephrectomies | The reported ischemia, tumor/margin and 83% same-day-discharge findings concern the partial-nephrectomy subgroup | One positive margin is one of 12 partial nephrectomies, not one of 18 heterogeneous operations. This small series cannot prove elimination of positioning injury or safety across all BMI/ASA categories.[5] |
| Cannoletta 2024 LAA comparison: 102 partial nephrectomies | Median stay 10 hours for 34 LAA cases versus 24 hours for 68 standard-access cases | The comparator combined 26 transperitoneal and 42 posterior retroperitoneal cases. This was observational, not a randomized comparison of incisions.[6] |
| Ramos 2024 transvesical simple prostatectomy: 117 cases | Median console time 107 minutes; 95.8% discharged within 24 hours; persistent urinary improvement at one year | “Within 24 hours” is not necessarily same-calendar-day discharge; console time is not total operating time. The report also described two suspected gas/air emboli attributed to high insufflation pressures.[8] |
| Kaouk 2021 transvesical radical prostatectomy: 20 patients | 75% continent within 48 hours and 85% within 10 days after catheter removal | These figures belong to the initial 20-patient series, not the later 210-case report. They do not establish the fastest recovery of all approaches.[9] |
| Ramos 2025 transvesical radical prostatectomy: 210 cases | Median blood loss 70 mL and console time two hours; 92% of planned outpatient cases discharged within 24 hours | Keep the outpatient denominator, timing and study-specific endpoints separate from earlier continence results.[10] |
The transvesical simple-prostatectomy series omitted drains and continuous irrigation routinely within that center's protocol. This is not a blanket postoperative instruction for every patient. The possibility of gas embolism and other complications requires a coordinated insufflation and anesthesia plan; the favorable recovery reports do not justify unmonitored pressure escalation.[8]
Cosmesis and Patient Counseling
Raver's 111-patient observational cohort included 54 multiport and 57 SP patients; only 27 had an SP umbilical incision. Adjusted analysis found less scar bother with SP umbilical access versus multiport (OR 0.08, 95% CI 0.01–0.38). This supports discussing scar location, especially with patients who value cosmesis, but does not validate a universal four-place ranking of incision sites or show that one incision gives the least pain and fastest continence recovery.[11]
Discuss the intended incision and corridor, the possibility of assistant/additional ports or conversion, catheter expectations and procedure-specific risks. Discharge depends on the operation, patient, local pathway and support at home. Small selected series, nonsignificant comparisons and scar questionnaires cannot establish equivalent long-term urinary, sexual or oncologic outcomes.
References
1. Intuitive. Da Vinci SP system and accessories. System information; instrument/accessory catalog.
2. Santarelli V, Valenzi FM, Haberal HB, et al. Current status of single port robotic-assisted reconstructive urology: a systematic review, meta-analysis and structured summary of the available literature. J Robot Surg. 2025. doi:10.1007/s11701-025-02509-9. Full text.
3. Floating docking technique: a simple modification to improve the working space of the instruments during single-port robotic surgery. World J Urol. 2021. Primary study.
4. Lenfant L, Wilson CA, Sawczyn G, et al. Single-port robot-assisted dismembered pyeloplasty with mini-Pfannenstiel or peri-umbilical access: initial experience in a single center. Urology. 2020;143:147–152. doi:10.1016/j.urology.2020.05.041.
5. Pellegrino AA, Chen G, Morgantini L, Calvo RS, Crivellaro S. Simplifying retroperitoneal robotic single-port surgery: novel supine anterior retroperitoneal access. Eur Urol. 2023;84:223–228. doi:10.1016/j.eururo.2023.05.006.
6. Cannoletta D, Pellegrino AA, Pettenuzzo G, et al. Surgical outcomes of novel retroperitoneal low anterior vs posterior and transperitoneal access in single-port partial nephrectomy. World J Urol. 2024;42:387. doi:10.1007/s00345-024-05096-w.
7. Khalil MI, Joseph JV. Extraperitoneal single-port robot-assisted radical prostatectomy. J Endourol. 2021;35(S2):S100–S105. doi:10.1089/end.2021.0440.
8. Ramos R, Ferguson E, Abou Zeinab M, et al. Single-port transvesical robot-assisted simple prostatectomy: surgical technique and clinical outcomes. Eur Urol. 2024;85:445–456. doi:10.1016/j.eururo.2023.11.012.
9. Kaouk J, Beksac AT, Abou Zeinab M, et al. Single port transvesical robotic radical prostatectomy: initial clinical experience and description of technique. Urology. 2021;155:130–137. doi:10.1016/j.urology.2021.05.022.
10. Ramos R, Soputro N, Pedraza AM, et al. Single port transvesical robot assisted radical prostatectomy. J Endourol. 2025;39(S1):S39–S46. doi:10.1089/end.2024.0291.
11. Raver M, Implicito C, Henrich M, et al. Does incision location matter? Analysis of single-port cosmesis in urologic reconstructive surgery. J Endourol. 2024;38:1364–1371. doi:10.1089/end.2024.0322.