Single-port vs. multi-port robotic radical prostatectomy: an umbrella review of meta-analyses

Single-port robotic-assisted radical prostatectomy (SP-RARP) has emerged as a minimally invasive alternative to conventional multi-port RARP (MP-RARP), aiming to reduce surgical access morbidity while maintaining oncological and functional outcomes. We performed an umbrella review to synthesize and critically appraise the available meta-analytic evidence comparing SP-RARP and MP-RARP. A systematic search of MEDLINE, EMBASE, and CENTRAL was conducted from inception to December 2025. Meta-analyses comparing SP-RARP with MP-RARP in adults undergoing radical prostatectomy for prostate cancer were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using AMSTAR-2. Outcomes evaluated included perioperative, functional, oncological, cosmetic, and economic parameters. Due to overlap of primary studies and methodological heterogeneity, findings were synthesized descriptively. Eight meta-analyses were included. Across pooled evidence, SP-RARP demonstrated significantly shorter hospital stay, smaller incision length, reduced postoperative pain, lower opioid requirements, and greater feasibility for ambulatory or same-day discharge pathways. Operative time, console time, estimated blood loss, and overall complication rates were generally comparable between approaches. Functional outcomes, including urinary continence and potency recovery, showed no significant differences. Similarly, oncological outcomes such as positive surgical margin rates and biochemical recurrence were equivalent. Current evidence suggests that SP-RARP is a safe and feasible alternative to MP-RARP, offering improved recovery and cosmetic outcomes without compromising oncological or functional results. However, the certainty of evidence remains limited by methodological weaknesses and predominantly retrospective data. High-quality prospective multicenter studies with long-term follow-up are needed to define the role of SP-RARP in contemporary prostate cancer surgery.