Single-port robot-assisted pyeloplasty versus multiport pyeloplasty: evidence from controlled trials

This study evaluates and compares the results of single-port (SP-RAP) versus multi-port robot-assisted laparoscopic pyeloplasty (MP-RAP) for the treatment of ureteropelvic junction obstruction (UPJO). A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies comparing SP-RAP and MP-RAP for UPJO treatment were identified from PubMed, Web of Science, and Cochrane Library databases. Key outcomes included operative time, hospital stay, and complication rates. Weighted mean differences (WMD) and risk ratios (RR) were calculated using fixed- or random-effects models based on heterogeneity. Statistical significance was set at P < 0.05. Both SP-RAP and MP-RAP demonstrated comparable surgical success rates (SP-RAP: 98.85%, MP-RAP: 98.08%), complication rates, and estimated blood loss. In the adult subgroup, SP-RAP was associated with shorter hospital stays (WMD: -0.52 days; P = 0.04). Postoperative morphine consumption was also lower in the SP-RAP group (WMD: -31.02 mg; P = 0.03), reflecting its minimally invasive nature. However, no significant differences were observed in operative time, pain scores, or renal function recovery between the two groups. Additionally, some studies suggested that SP-RAP may offer better cosmetic outcomes due to its single incision; however, due to the lack of standardized cosmetic satisfaction evaluation criteria, this finding is presented as a potential advantage rather than a definitive conclusion. The SP system demonstrates comparable safety and effectiveness to MP-RAP while offering advantages in cosmetic outcomes and recovery. Further long-term studies are needed to validate its benefits and optimize its application.