Clinical Implications for da Vinci SP Partial Nephrectomy in High-Complexity Tumors: Propensity Score-Matching Analysis

To compare surgical outcomes between robot-assisted laparoendoscopic single-site (R-LESS) surgery using the da Vinci Si or Xi system and the da Vinci SP system for partial nephrectomy. From 2008 to 2020, 66 partial nephrectomies were performed using a single-site robotic approach: 44 used the da Vinci Xi or Si system (R-LESS group) and 22 used the da Vinci SP system (SP group). After 1:1 propensity score matching, surgical outcomes were compared between groups. Median patient age was 51.5 years. Median tumor size was 2.1 cm and was not significantly different between groups. Median operation time was longer in the R-LESS group (R-LESS vs SP: 180 vs 155 minutes, p = 0.034), but median warm ischemic time was comparable between groups. Estimated blood loss was higher in the R-LESS group (R-LESS vs SP: 215 vs 20 mL, p < 0.001). Median operation time was significantly shorter in the SP group in patients with moderate- to high-complexity tumors (R-LESS vs SP: 200 vs 172 minutes, p = 0.035). Rates of trifecta achievement were similar between groups (63.6% in both groups, p = 1.00). R-LESS and da Vinci SP methods are both feasible approaches for single-site incision robotic partial nephrectomy. The da Vinci SP platform allows "true" single-site surgery without additional ports and provides a wider working space. It was associated with better performance than R-LESS partial nephrectomy. In complex tumors, operation time was shorter with SP partial nephrectomy than with R-LESS partial nephrectomy, suggesting that the SP method is especially advantageous for managing complex renal tumors.