Perioperative efficiency and clinical outcomes of single-port versus multi-port robot-assisted radical prostatectomy:...

The relative benefits of single-port (SP) versus multi-port (MP) robot-assisted radical prostatectomy (RARP) for prostate cancer remain uncertain, with conflicting evidence reported in the literature. This systematic review aimed to compare perioperative outcome metrics, oncologic efficacy, and functional recovery outcomes between SP-RARP and MP-RARP. A thorough literature search was conducted using PubMed, Embase, Web of Science, and the Cochrane Library to locate English-language research published until June 2025. All statistical analyses, encompassing meta-analyses, were performed utilizing R software (version 4.3.1). Weighted mean differences (WMDs) and 95% CIs were used to summarize continuous outcomes, while odds ratios (ORs) with 95% CIs were computed for dichotomous variables. Statistical significance was established at P < 0.05. The review protocol was registered prospectively in PROSPERO (CRD420251114408). A total of 15 studies involving 3,116 patients (SP-RARP: 1,525; MP-RARP: 1,591) were included. Patients undergoing SP-RARP experienced significantly lower estimated blood loss (WMD -41.36 (-68.79, -13.94); P = 0.003), shorter hospital stays (SMD -0.95 (-1.77, -0.13); P = 0.02), and earlier urinary catheter removal (WMD -1.77 (-2.88, -0.66); P = 0.002) compared with those receiving MP-RARP. SP-RARP was also associated with lower pain scores on the day of surgery (WMD -0.88 (-1.29, -0.48); P < 0.001) and reduced opioid use during hospitalization (OR 0.35 (0.22, 0.54); P < 0.001) and at discharge (OR 0.03 (0.01, 0.10); P < 0.001). Nonetheless, for functional outcomes related to potency and continence, along with perioperative complications, positive surgical margins, biochemical recurrence, and duration of surgery, no statistically significant differences were seen between the groups. SP-RARP offers advantages in reducing intraoperative blood loss, accelerating recovery, and improving postoperative pain control compared to MP-RARP. Although operative time is longer, both approaches provide comparable oncological and functional outcomes.