Icahn School of Medicine at Mount Sinai, New York, NY.
Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
Urol Oncol. 2025 Jan;43(1):63.e1-63.e6. doi: 10.1016/j.urolonc.2024.09.017. Epub 2024 Oct 8.
Single-port (SP) robotic surgical system performs well in small anatomical spaces, which makes it suitable for retroperitoneal robotic partial nephrectomy (RPN). However, there is limited evidence comparing the safety and feasibility of SP RPN to multiport (MP) RPN. To address this gap in evidence, we sought to analyze and compare the safety of retroperitoneal RPN between SP and MP approaches.
This is a retrospective cohort study using data from the Single Port Advanced Research Consortium (SPARC) and a multicenter database of patients who underwent retroperitoneal RPN using either SP or MP between 2017 and 2023. Baseline, perioperative, and postoperative data were compared using t-tests, Mann-Whitney U test, χ test, and Fisher exact test. Multivariable analyses were conducted using robust and Poisson regressions.
A total of 286 patients (SP RPN, n = 86 [30%]; MP RPN, n = 200 [70%]) underwent retroperitoneal RPN. R.E.N.A.L nephrometry score and tumor location were significantly different between the 2 groups. Notably, the ischemia time was significantly shorter in the MP group (16 vs. SP, 22 minutes, P < 0.001). Adjusting for baseline characteristics, the ischemia time was approximately 7.89 minutes longer for patients in the SP group compared to the MP group, on average (95% CI: 5.87, 9.92; P < 0.001). No significant differences were observed in operative time, EBL, blood transfusion, conversion rates, LOS, PSM, and overall 30-day postoperative complications between the 2 groups.
Our study shows that retroperitoneal SP and MP RPN have comparable perioperative and postoperative outcomes, except for the longer ischemia time in the SP platform. SP RPN is a safe and viable alternative; however, further research is needed to explore its potential benefits, cost-effectiveness, and long-term oncologic outcomes.
单端口 (SP) 机器人手术系统在小解剖空间中表现良好，这使其适用于后腹腔镜机器人部分肾切除术 (RPN)。然而，关于 SP RPN 与多端口 (MP) RPN 的安全性和可行性的证据有限。为了弥补这一证据空白，我们旨在分析和比较 SP 和 MP 后腹腔镜 RPN 的安全性。
这是一项回顾性队列研究，使用了来自单端口高级研究联盟 (SPARC) 和 2017 年至 2023 年间使用 SP 或 MP 进行后腹腔镜 RPN 的多中心数据库的数据。使用 t 检验、Mann-Whitney U 检验、χ 检验和 Fisher 确切检验比较基线、围手术期和术后数据。使用稳健和泊松回归进行多变量分析。
共有 286 名患者（SP RPN，n=86 [30%]；MP RPN，n=200 [70%]）接受了后腹腔镜 RPN。两组的 R.E.N.A.L 肾肿瘤评分和肿瘤位置有显著差异。值得注意的是，MP 组的缺血时间明显更短（16 比 SP，22 分钟，P < 0.001）。在调整基线特征后，SP 组患者的缺血时间比 MP 组平均长约 7.89 分钟（95%CI：5.87，9.92；P < 0.001）。两组之间的手术时间、EBL、输血、转换率、 LOS、PSM 和总体术后 30 天并发症没有显著差异。
我们的研究表明，后腹腔镜 SP 和 MP RPN 的围手术期和术后结果相当，除了 SP 平台的缺血时间更长。SP RPN 是一种安全可行的替代方案；然而，需要进一步研究来探讨其潜在的益处、成本效益和长期肿瘤学结果。
