Why a Surgeon Who Uses Both Multi-Port and Single Port Systems Matters
By Prof. Dr. Murat Binbay · Professor of Urology · Uro-oncology and Robotic Surgery · Istanbul · Reading time about 8 minutes
When men research robotic prostate surgery, most of the effort goes into comparing technologies: multi-port or single port, this generation of robot or that one. Far less attention goes to the question that actually determines the outcome — who is holding the controls, and how that person decides what to do with them. This article is about choosing a surgeon. It makes one central argument, and then widens into the other things worth looking for.
The Central Argument in One Paragraph
A robot does not perform surgery; a surgeon performs surgery with a robot. There are now two robotic systems in common use for prostate cancer: the multi-port system, with five or six small incisions, and the single port system, with one. Neither is better in every case. Each is better for certain patients. A surgeon who uses only one system will, with the best intentions, fit the patient to the system he has. A surgeon who uses both can fit the system to the patient. That difference is not a detail; for some patients it is the difference between a straightforward recovery and a difficult one, or between an operation that is possible and one that is refused.
The Problem with a One-System Surgeon
This is not a criticism of individual surgeons. It is a structural problem, and it works in both directions.
A surgeon who uses only the multi-port system has no reason to think about the patients for whom single port would have been gentler: the man with heart disease who cannot safely tolerate the steep head-down position; the man with extensive scar tissue from earlier abdominal surgery; the man with a high body weight; the man who simply wants to go home the next morning and avoid strong painkillers. These patients will be told, correctly, that multi-port surgery is possible — but they will not be told that a different route existed.
A surgeon who uses only the single port system faces the opposite temptation. Having invested in a newer technology, there is a natural pull to apply it broadly. But some patients should not have single port surgery: those who need extended lymph node removal for high-risk cancer, those with a very large prostate, those whose cancer has clearly spread beyond the capsule. For them, the wider working space of the multi-port system is safer and more complete. A single-system surgeon may stretch the indication; a two-system surgeon simply switches.
In both cases the patient hears a confident recommendation. The problem is that it is a recommendation shaped by what the surgeon has, not by what the patient needs.
What Each System Is Actually Good At
Current scientific evidence shows that in experienced hands the two systems produce the same cancer control, the same long-term continence and the same major complication rates. They differ in route and in recovery. A fair summary:
| Multi-port | Single port | |
|---|---|---|
| Working space | Wide; instruments enter the abdominal cavity | Confined; usually stays outside the abdominal cavity |
| Patient position | Steep head-down | Nearly flat |
| Best suited to | High-risk cancer, extended lymph node removal, very large prostate, cancer beyond the capsule | Organ-confined cancer, previous abdominal surgery, heart or lung disease, high body weight, patients prioritising fast recovery |
| Typical stay | One to two nights | Next morning; same day in selected patients |
| Track record | Over two decades | Since 2018, with a rapidly growing evidence base |
Neither column is “better”. The right column for you depends on your disease and your body. A surgeon fluent in both can read your MRI and your history and tell you which — and, just as importantly, can change the plan if the picture changes. The comparison is set out in more depth in single port vs multi-port robotic prostatectomy.
How a Two-System Surgeon Decides
In our practice the decision follows a fixed order, and we explain it to every patient in writing.
- The cancer comes first. Stage, grade, PSA, the MRI and the biopsy map determine what the operation must achieve: whether nerve-sparing is realistic, whether lymph nodes must be removed and how widely. If the cancer needs the multi-port system’s reach, that settles it.
- Then the body. Previous operations, heart and lung health, body weight, prostate size. If the cancer allows either system, these factors usually decide — and they often point to single port.
- Then the patient’s priorities. Speed of recovery, travel constraints, concern about painkillers, the scar. These never override the first two, but between two equally good options they are what matter.
The written plan states which system we recommend, why, and what the alternative would have offered. Patients are encouraged to show it to another surgeon. A good plan does not fear a second opinion. If you would like to sort your own reports into this order first, the single port candidate checklist follows the same three steps.
What Else to Look for in a Robotic Prostate Surgeon
Fluency with both systems is one marker. Several others matter as much.
- Experience with the full range of prostate operations, from straightforward organ-confined cancer to salvage surgery after radiotherapy. A surgeon who handles the difficult cases handles the simple ones with margin to spare.
- Depth in the wider field. Robotic prostatectomy sits within uro-oncology; a surgeon who also treats kidney and bladder cancer, and who sees patients through the whole pathway from diagnosis to follow-up, brings judgement that a procedure-only specialist may not. (See robotic surgery in the treatment of urologic cancers.)
- An academic footprint. Publications, teaching, roles in international societies and invitations to demonstrate or proctor are external checks on competence. They are not a guarantee, but they are harder to fake than a website.
- A hospital with the infrastructure to match: both robotic systems available, an experienced anaesthesia team, intensive care on site, and an international patient office if you are travelling.
- A willingness to say no. The surgeon who tells you that you are not a candidate for the operation you asked for, or that surveillance is the better option, is the surgeon who will also tell you the truth afterwards.
- Transparency about limits. Every surgeon has complications. One who discusses them openly, and explains how they are prevented and managed, is more trustworthy than one who implies they do not occur.
Questions to Ask Any Robotic Prostate Surgeon
Take these to every consultation, in person or online. The answers — and the ease with which they are given — will tell you most of what you need to know.
- Do you use both the multi-port and the single port system? Which do you recommend for me, and why?
- What would the other system have offered in my case?
- Is nerve-sparing realistic for me, and on which side?
- Will lymph nodes be removed, and how extensively?
- What is your approach if the findings during surgery differ from the MRI?
- What complications should I be aware of, and how are they managed?
- How will I be followed up after I return home?
- May I have your recommendation in writing to discuss with another surgeon?
A surgeon who welcomes the last question has nothing to hide.
A Note on “The Best Surgeon”
Patients often search for the best robotic prostate surgeon. The honest answer is that no such ranking exists, and anyone who claims the title should be treated with caution. What exists is the right surgeon for your case: one who has the tools your disease requires, the experience to use them, and the judgement to tell you which tool that is. The purpose of this page is to help you recognise that surgeon when you meet one — here or anywhere else.
You can read more about our own background and practice on the about page.
Frequently Asked Questions
Is a surgeon who uses both systems automatically better than one who uses one?
Not automatically. An excellent one-system surgeon can outperform an average two-system surgeon. But for the same level of skill, the two-system surgeon can offer a wider and more honest choice.
Should I choose the surgeon or the hospital first?
The surgeon. The hospital must have the infrastructure, but the decision and the operation are the surgeon’s.
How many operations should a surgeon have done?
Experience matters, and the learning curve for robotic prostatectomy is real. But a number alone tells you little without knowing the case mix and the outcomes. Ask about the range of cases rather than a figure.
I have been told I am not a candidate for robotic surgery. Should I seek another opinion?
Yes, particularly if the reason given was heart or lung disease, previous abdominal surgery or body weight. These are often reasons for single port surgery rather than against robotic surgery.
How do I get a written opinion before deciding?
Send us your MRI, biopsy report and PSA history. You will receive a written assessment stating which system we would recommend and why.
Send Your Scans for Assessment
If you are choosing a surgeon for prostate cancer and would like a written opinion on which robotic system suits your case, you can send your imaging and reports for a preliminary review. We reply within two business days. Tel: +90 530 100 90 85
This article is for general information only and does not replace an individual medical consultation. Treatment decisions are made after a personal assessment with your surgeon.
