What the Evidence Says About Single Port Prostatectomy
A plain-language review of the evidence on single port prostatectomy: cancer control, continence, recovery, its costs and what studies cannot yet tell you.
A Plain-Language Review of the Studies
By Prof. Dr. Murat Binbay · Professor of Urology · Uro-oncology and Robotic Surgery · Istanbul · Reading time about 9 minutes
If you have searched for single port prostatectomy, you have already met two kinds of writing. One kind promises everything: less pain, no scars, faster recovery, better results. The other dismisses the whole idea as marketing. Neither helps a man who has to make a decision about his own cancer.
What helps is the evidence, read carefully and explained plainly. That is what this page does. I will tell you what the published studies show, how confident we can be in each finding, and — just as important — what the studies cannot yet tell you. You should leave this page able to judge any surgeon’s claims, including mine.
First, How to Read the Evidence
Medical evidence comes in levels. At the top are randomised trials, in which patients are allocated to one operation or another by chance, so that the groups are truly comparable. Below them are comparative studies, in which surgeons report the results of patients who happened to receive one operation or the other. Above both sits the meta-analysis, which pools many studies together to produce a single, more reliable estimate.
For single port prostatectomy, there are as yet no large randomised trials. What we do have is a growing body of comparative studies and, since 2021, a series of meta-analyses that pool them — the most recent including several thousand patients and published in leading journals, among them European Urology. That is a solid foundation for the short-term questions. It is not yet a foundation for every long-term question, and I will be clear about where the line falls.
The Question That Matters Most: Is the Cancer Removed as Well?
Yes. This is the most consistent finding across every pooled analysis.
The main short-term measure of cancer control after prostatectomy is the surgical margin: whether any cancer cells are found at the edge of the removed prostate. Every meta-analysis comparing single port with conventional multi-port robotic surgery has found the same margin rates with both. Where studies have followed patients for the early rise of PSA that signals a returning cancer, they have again found no difference.
In plain terms: when the right patient is chosen, the cancer operation performed through a single port is the same cancer operation. How the two systems compare in everyday practice is described in single port vs multi-port robotic prostatectomy.
Urinary Control and Erections
The next questions every man asks are whether he will be dry and whether he will keep his erections. Pooled across the published studies, recovery of urinary control and of erectile function has been comparable with single port and multi-port surgery. Some individual series report faster early continence with particular single port routes — most notably the transvesical approach, performed from inside the bladder — but across all studies the honest summary is: no worse, and in selected routes possibly earlier.
This should not surprise anyone. Continence and erections depend above all on the cancer, on the anatomy, and on how carefully the surgeon preserves the nerves and the supporting tissues. The platform is a tool for that care; it does not replace it. The practical side of regaining control is covered in urinary continence after prostate surgery.
Where Single Port Makes a Measurable Difference: Recovery
This is where the evidence speaks most clearly in favour of single port surgery. Across the pooled analyses, men who had single port prostatectomy experienced:
- A shorter hospital stay. Every meta-analysis has found this, typically a reduction of about a day, and in many centres a same-day or next-morning discharge.
- Less pain and fewer opioid painkillers. Pain scores on the day of surgery were lower, and far fewer men needed opioid medication in hospital or at discharge.
- Less blood loss. Modest in absolute terms, but consistent.
- Earlier catheter removal. In pooled data the catheter came out on average one and a half to almost three days sooner, especially with the extraperitoneal route.
For a man who is working, travelling, or simply wants his life back quickly, these are not small things.
Where Single Port Asks Something in Return
An honest review also reports the costs.
- The operation can take slightly longer. The most recent pooled analysis found a difference of around ten minutes.
- Fewer lymph nodes may be removed. Across urological operations, pooled data show a smaller lymph node yield with single port surgery. For men with high-risk cancer who need extended lymph node removal, this matters — and it is one reason those men are often better served by the multi-port system.
- Not every man is a candidate. The results above come from patients selected for single port surgery. They do not mean that every prostate, every cancer and every body is suited to it.
The points that decide whether you are a candidate are listed in is single port surgery right for me? A candidate checklist.
The Evidence at a Glance
| What you want to know | What the pooled studies show | How confident we can be |
|---|---|---|
| Cancer at the surgical margin | No difference | Consistent across all analyses |
| Early PSA recurrence | No difference so far | Moderate; follow-up still short |
| Complications | No difference | Consistent |
| Urinary control | Comparable; possibly earlier with some routes | Moderate |
| Erectile function | Comparable | Moderate |
| Hospital stay | Shorter with single port | Consistent |
| Pain and opioid use | Lower with single port | Consistent |
| Blood loss | Lower with single port | Consistent |
| Catheter time | Shorter with single port | Moderate |
| Operating time | Slightly longer with single port | Moderate |
| Lymph nodes removed | Fewer with single port | Moderate |
What the Evidence Cannot Yet Tell You
This is the part most websites leave out.
- There are no large randomised trials yet. Every comparison so far is between groups of patients who were not allocated by chance. Researchers adjust for this, but cannot remove it entirely. The authors of the most recent analyses describe the certainty of several findings as low.
- Long-term cancer follow-up is shorter. The da Vinci SP system was approved for urology in 2018. We know a great deal about margins and early PSA; we know less, as yet, about results at ten and fifteen years. There is no reason to expect them to differ when the same operation is performed, but it has not yet been measured.
- Most results come from experienced centres. Results reported by surgeons with large single port experience may not apply to a surgeon early in that experience.
- Studies mix different routes. Single port prostatectomy can be performed through the abdomen, around it, or through the bladder, and these routes differ from one another. A pooled average can hide those differences. The routes are compared in extraperitoneal vs transperitoneal robotic prostatectomy.
Five Questions to Ask Any Surgeon
Whether you come to me or go elsewhere, these questions will tell you a great deal.
- Which route would you use for me, and why? A clear answer means the plan was made for you.
- Do you also perform multi-port surgery? A surgeon who uses both systems can choose for you rather than for the equipment.
- Would you remove lymph nodes in my case, and how widely? If the answer is “extensively”, ask whether single port is still the right tool.
- What do the published studies say, and what do they not say? A surgeon who can tell you the limits of the evidence is one who has read it.
- Will I receive the plan in writing? A good plan is one you can show to someone else.
How I Use This Evidence
The studies do not tell me what to do for you; they tell me what is possible and where the limits are. Your MRI, your biopsy map, your PSA, your previous operations and your priorities tell me the rest.
In practice that means a simple rule. Where your cancer and your anatomy allow it, single port surgery offers a recovery the evidence clearly supports — less pain, a shorter stay, a quicker return to life — with the same cancer control. Where your cancer needs a wider operation, I will recommend the multi-port system and tell you why. Using both systems, I have no reason to fit you to one.
Frequently Asked Questions
Is single port prostatectomy experimental?
No. The da Vinci SP system has been approved for urological surgery since 2018 and is used in leading centres in the United States, Europe and Asia. What is still being studied is its long-term record, not its safety.
Will single port surgery cure my cancer as well as conventional robotic surgery?
The published studies show the same rate of cancer at the surgical margin and, so far, the same early PSA results. This holds when patients are properly selected.
Will I be dry sooner?
Possibly, particularly with some routes, but across all studies continence recovery has been comparable rather than clearly faster. Nobody can promise the first day.
Why don’t you quote your own results here?
Published, peer-reviewed results are the fairest basis for comparison, and regulations on medical information rightly limit how individual practices advertise their figures. I am happy to discuss what to expect in your own case during consultation.
What if I am not a candidate for single port surgery?
Then you will be told so, in writing, with the reasons and with the alternative we recommend. Not being a candidate for one tool does not mean losing the benefits of robotic surgery.
Let the Evidence Work for You
The studies describe averages. Your decision is about one man. Send your MRI images, biopsy report, PSA history and a list of previous operations, and within two business days you will receive a written assessment: whether single port surgery is suitable for you, which route we would use, and what we would recommend if it is not. The letter is yours to show to any other surgeon.
Good evidence and a good plan have one thing in common: neither fears a second look.
Send us your imaging and reports · Tel: +90 530 100 90 85
Studies Referred To
- Ficarra V, et al. Comparison of single- and multiport robot-assisted approaches in prostate and renal surgery: a systematic review and meta-analysis. Eur Urol. 2025;88(6):589–613. doi:10.1016/j.eururo.2025.08.010
- Xiao X, et al. Perioperative efficiency and clinical outcomes of single-port versus multi-port robot-assisted radical prostatectomy: an updated meta-analysis. J Robot Surg. 2025;19:492. doi:10.1007/s11701-025-02679-6
- Mirza W, et al. da Vinci single-port versus da Vinci Xi multiport robot-assisted radical prostatectomy: a GRADE-assessed systematic review and meta-analysis. BMC Surg. 2026;26. doi:10.1186/s12893-026-03950-9
- Furlam PL, et al. Single port extraperitoneal versus multiport transperitoneal radical prostatectomy: a systematic review and meta-analysis. Clin Genitourin Cancer. 2026;24(4):102555. doi:10.1016/j.clgc.2026.102555
- Hinojosa-Gonzalez DE, et al. Single-port versus multiport robotic-assisted radical prostatectomy: a systematic review and meta-analysis on the da Vinci SP platform. Prostate. 2022;82(4):405–414. doi:10.1002/pros.24296
- Ge S, et al. Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries. World J Urol. 2024;42:18. doi:10.1007/s00345-023-04711-6
- Soputro NA, Kaouk J. Single-port robot-assisted radical prostatectomy. World J Urol. 2024;42:245. doi:10.1007/s00345-024-04914-5
- Biasatti A, et al. The current landscape of single-port robotic surgery in urology. Nat Rev Urol. 2025;23(3):156–173. doi:10.1038/s41585-025-01081-z
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.
