The landscape of surgical oncology has evolved dramatically over the past two decades, particularly in the field of urologic cancers. Traditional open surgery — once the gold standard — has gradually been replaced by minimally invasive techniques, driven by the promise of reduced morbidity, faster recovery, and comparable oncologic outcomes. Among these advances, robot-assisted surgery has emerged as a transformative force, with the da Vinci Single-Port (SP) system representing the latest leap in surgical precision and access.

This article explores the current and potential applications of single-port robotic surgery in managing prostate, kidney, and bladder cancers, with a focus on the technical, functional, and oncologic implications of the da Vinci SP platform.

Introduction to the da Vinci SP System

The da Vinci SP system, developed by Intuitive Surgical, is a robotic-assisted surgical platform designed for single-incision procedures. Unlike multi-port systems that require multiple trocars, the SP system deploys three multi-jointed instruments and a flexible 3DHD endoscope through a single 2.5 cm cannula.

This compact design allows for 360-degree anatomical access, ideal for deep pelvic and retroperitoneal surgeries, where workspace is limited and anatomical precision is critical. For urologic surgeons, this means enhanced reach and articulation within confined spaces — particularly relevant in prostatectomy, nephrectomy, and cystectomy.

1- Robotic-Assisted Radical Prostatectomy (RARP)

Radical prostatectomy is a cornerstone in the management of localized prostate cancer. The da Vinci SP system allows for an extraperitoneal or transperitoneal approach through a single umbilical incision. This has demonstrated several advantages in early studies:

• Reduced postoperative pain due to decreased abdominal wall trauma

• Superior cosmetic results, with near-scarless outcomes

• Ergonomic dissection in the narrow confines of the male pelvis

• Enhanced preservation of neurovascular bundles, potentially improving continence and sexual function outcomes

Clinical Evidence

A growing body of literature has supported the feasibility and safety of SP-RARP. In a study by Kaouk et al. (2020), SP-RARP demonstrated comparable oncologic outcomes to multiport robotic approaches, with shorter hospital stays and faster return to baseline function.

Additionally, SP access allows surgeons to perform retzius-sparing prostatectomy with greater anatomical control, which may further benefit postoperative continence.

2- Partial and Radical Nephrectomy

For renal tumors, especially those requiring nephron-sparing surgery, the SP platform offers unique advantages in terms of reduced parietal trauma and better instrument triangulation from a single entry point.

Advantages of SP for Kidney Surgery:

• Ideal for retroperitoneal access in posterior tumors

• Minimized muscular disruption in flank incisions

• Improved cosmetic and recovery profiles

• Enhanced ergonomics for upper pole tumor excision

In partial nephrectomy, precision is key to achieving negative margins while preserving renal function. The SP system’s flexible instruments and high-definition 3D vision allow surgeons to work around vascular structures and renal parenchyma with millimetric accuracy.

3- Radical Cystectomy and Urinary Diversion

Bladder cancer management, particularly in muscle-invasive disease, often requires radical cystectomy with urinary reconstruction. While traditionally a morbid procedure, robotic assistance has reduced perioperative complications. The SP platform is now being investigated for its feasibility in intracorporeal cystectomy and diversion procedures.

Emerging Use Cases:

• Intracorporeal ileal conduit or neobladder reconstruction through a single port

• Pelvic lymph node dissection with full maneuverability

• Reduced wound morbidity, particularly beneficial in obese or frail patients

While long-term data are still forthcoming, early experiences suggest that the SP approach may facilitate more streamlined intracorporeal techniques, particularly for surgeons experienced in multiport robotic cystectomy.

4- Functional and Quality of Life Outcomes

Beyond oncologic efficacy, one of the key goals in modern urologic oncology is the preservation of function — whether that’s renal function, urinary continence, or sexual health.

By limiting the number of abdominal incisions, single-port robotic surgery may reduce:

• Postoperative ileus and incisional hernias

• Pain-related mobility limitations

• Length of hospital stay and opioid requirement

Moreover, the improved visualization and articulation can contribute to more precise nerve-sparing, better vascular control, and optimized reconstructive techniques.

5- Limitations and Considerations

While promising, the SP system also presents certain limitations:

• Learning curve: Mastery of SP techniques requires significant robotic experience.

• Limited instrument availability: Compared to multiport platforms, fewer tools are currently SP-compatible.

• Cost and access: As with all robotic systems, institutional investment and training are necessary.

Nonetheless, as experience grows and technology matures, these barriers are expected to diminish.

The da Vinci SP system represents a technological evolution in urologic cancer surgery, offering the potential for less invasive yet equally effective treatment options. From radical prostatectomy to complex urinary reconstructions, single-port robotic surgery is reshaping what’s possible in surgical oncology.

As evidence continues to build, the SP platform may become the new standard for select urologic cancer procedures — delivering on the promise of better outcomes, quicker recovery, and improved patient satisfaction.