Single-Port Partial Nephrectomy: State of the Art and Future Directions

Partial nephrectomy (PN) has evolved from an imperative to an elective procedure, now representing the standard of care for localized renal masses. The introduction of robotic surgery has expanded the feasibility and precision of minimally invasive nephron-sparing surgery. The single-port (SP) robotic platform, specifically designed to operate through a single incision, aims to further minimize invasiveness and improve postoperative recovery and cosmetic outcomes. Early experiences with SP robot-assisted PN (SP-RAPN) demonstrated encouraging perioperative, oncological, and functional results comparable to those achieved with the multi-port (MP) approach. The retroperitoneal route, particularly through the lower anterior access (LAA), has shown anesthesiological and surgical advantages, including shorter operative times, reduced pain, and faster discharge. Comparative studies indicate similar safety and cancer-control outcomes between SP and MP-RAPN, with SP offering shorter hospital stays but slightly longer Warm Ischemia Times (WITs). Ongoing technological advancements, artificial intelligence (AI) integration, and refined patient selection tools are expected to further enhance the precision, reproducibility, and accessibility of SP-RAPN.

SP-RAPN offers comparable oncological and functional outcomes to multi-port RAPN (MP-RAPN) while further reducing surgical invasiveness and improving cosmetic results. Careful patient selection remains crucial, with low- to intermediate-complexity tumors being most suitable during the early learning phase. Among the available access routes, retroperitoneal and LAA techniques have gained particular attention for their perioperative and anesthesiological benefits. Although SP-RAPN is associated with slightly longer WITs, it provides advantages in terms of postoperative pain, length of stay, and feasibility in outpatient settings. Ongoing technological innovations, including AI, advanced imaging, and improved robotic articulation, are expected to refine surgical precision and broaden adoption.

SP-RAPN is a safe and feasible evolution of nephron-sparing surgery with outcomes comparable to MP-RAPN. The retroperitoneal and LAA approaches offer notable perioperative and anesthesiological advantages. Proper patient selection and structured training programs are key to optimizing outcomes and overcoming technical challenges. Future advances in robotic technology and digital integration will further enhance the role of SP-RAPN in minimally invasive urologic surgery.