Single-port versus multi-port robot-assisted partial nephrectomy: a multivariate analysis of the surgical trifecta

The purpose of this study is to compare trifecta achievement between single-port (SP) and multi-port (MP) robotic cohorts at a high-volume institution and to assess the impact of nephrometry score and demographic factors on these outcomes. Our institution's IRB-approved, prospective renal cancer database was used to identify 753 patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN) from 2017 to 2025. Patients were stratified into cohorts based on SP and MP RAPN approach. Trifecta rates for each group were compared between the cohorts using complete-case and multiple imputation data sets. Multiple logistic regression models assessed associations between trifecta achievement and surgical approach, age, sex, body mass index (BMI), nephrometry score, and tumor size. Alternatively, trifecta rates were stratified by the nephrometry score and the common odds ratio and heterogeneity was tested across the nephrometry score strata with Cochran-Mantel-Haenszel and Breslow-Day tests. Trifecta achievement did not differ significantly between the SP (N = 102; 76%) and MP (N = 494; 80%) groups (p = 0.46). Trifecta achievement odds were not significantly influenced by surgical platform choice (p = 0.052). Among the factors we analyzed, only nephrometry score was significantly associated with trifecta achievement, while surgical approach showed no significant association. We conclude that, for high-volume surgeons with experience using SP, there is no statistically significant difference in trifecta achievement between SP and MP RAPN after adjusting for age, sex, BMI, tumor size and nephrometry score. Limitations of this study include complete-case restriction and baseline characteristic imbalances between SP and MP cohorts.