Current status of single port robotic-assisted reconstructive urology: a systematic review, meta-analysis and...

Single Port (SP) surgery is the most relevant surgical innovation of the past six years. Few data are available on the advantages and disadvantages of SP Robotic-Assisted reconstructive urology. In the present systematic review, we summarize the results of available literature exploring the feasibility of SP reconstructive urological procedures and comparing the SP and Multi Port (MP) approaches. The MEDLINE, EMBASE and Cochrane Library Databases were systematically searched for articles evaluating outcomes of SP robotic-assisted pyeloplasty, ureteral reimplantation, Boari Flap, fistula repair, bladder diverticulectomy and vaginoplasty. After meticulous study selection, we conducted a meta-analysis to compare perioperative and postoperative outcomes of SP and MP robotic-assisted pyeloplasty (SP-RP and MP-RP). Regarding ureteric reimplantation, Boari Flap, bladder diverticulectomy, fistula repair and vaginoplasty, we underwent a structured narrative synthesis, since meta-analysis was not feasible due to heterogeneity or insufficient study numbers. The meta-analysis included a total of six retrospective cohort studies and 202 patients. SP-RP demonstrated significantly lower Estimated Blood Loss (EBL) (SMD - 0.45, 95%CI - 0.80 to  - 0.09, p = 0.01, I² = 0%) and better cosmetic results (MD 1.83, 95%CI 0.98-2.68, p < 0.001). The mean length of hospital stay was shorter for patients submitted to SP-RP, but the difference did not reach significance (SMD =  - 0.68, 95%CI - 1.43 to 0.07, p = 0.08, I² = 80%). There were no significant differences in terms of complication rates, operative times, success rate and renal function increase between the two approaches (p > 0.05). Respectively, a total of four, one, two, one and two articles evaluating robotic-assisted SP ureteral reimplantation, Boari Flap, bladder diverticulectomy, fistula repair, and vaginoplasty, were included for the final structured summary. The included studies consistently suggest the feasibility and safety of the SP approach, however, available evidence predominantly consists of small retrospective series or individual case reports, and statistical validation is not possible. SP-RP has been successfully described, with possible advantages in terms of shorter hospital stays, better pain control and cosmetic results. Although successful cases of other major reconstructive urological procedures are reported in the literature, the available evidence remains limited and of low quality. Hopefully, the encouraging findings regarding SP-RP will increase the popularity of the SP robotic system among reconstructive urologic surgeons and the availability of more robust data.