What Are the Advantages of Single Port Robotic Surgery for Prostate Cancer?
By Prof. Dr. Murat Binbay · Professor of Urology · Uro-oncology and Robotic Surgery · Istanbul · Reading time about 8 minutes
If you have been told that you need surgery for prostate cancer, you will probably have heard that robotic surgery is now the standard way of doing it. You may also have heard of a newer version — single port — and wondered whether it is simply a marketing term or a real difference. This article explains what single port surgery actually changes for a man having his prostate removed, what the scientific evidence supports, and, just as importantly, what it does not change. It is written for patients and families.
The Short Answer
Single port robotic surgery does not remove the cancer any better or any worse than conventional multi-port robotic surgery. What it changes is the route to the prostate and, as a result, how the days and weeks after the operation feel. For the right patient, that difference is real and worth having. For some patients, the conventional system remains the safer choice. The rest of this article explains why.
What Is Different About the Single Port Route to the Prostate?
In conventional multi-port robotic surgery, five or six small incisions are made across the abdomen. The instruments enter the abdominal cavity, the bowel is moved aside, and the patient is tilted steeply head-down so that gravity keeps the intestines away from the pelvis. The surgeon then works down to the prostate from above.
In single port surgery, a single incision of about 2.5 centimetres is made just below the navel. The camera and three articulating instruments pass through it together. Crucially, the surgeon can reach the prostate without entering the abdominal cavity at all — by creating a small working space directly in front of the bladder (the extraperitoneal route) or, for selected small tumours, through the bladder itself (the transvesical route). The bowel is never touched. The patient lies almost flat.
Every advantage described below follows from this one difference: the operation happens in a small, closed space next to the prostate rather than inside the abdomen.
The Advantages, One by One
1. Less pain and fewer strong painkillers
With one small incision and no manipulation of the bowel, most patients report noticeably less pain in the first days after surgery. Published series consistently show lower use of opioid painkillers after single port prostatectomy; many patients manage with simple paracetamol-type medication alone. For patients who are concerned about strong painkillers — or who simply wish to feel like themselves quickly — this is often the most immediately felt benefit.
2. A shorter hospital stay — sometimes no overnight stay
Because the bowel is undisturbed and pain is lower, patients are typically eating and walking within hours. In our practice most single port prostatectomy patients are discharged the following morning; selected patients can go home the same day. Multi-port surgery usually involves a stay of one to two nights. For patients travelling from abroad, a shorter stay also means a shorter and more predictable trip.
3. The bowel is left alone
In multi-port surgery the intestines are moved aside and exposed to the operating gas for the duration of the procedure. This is safe, but it is the main reason patients feel bloated, lose their appetite and sometimes have a sluggish bowel for several days afterwards. Single port surgery performed through the extraperitoneal route never enters the space where the bowel lies. Patients usually eat normally the same evening, and bowel function returns quickly.
4. No steep head-down position
The head-down tilt used in multi-port surgery raises the pressure in the chest, the eyes and the brain for the length of the operation. Healthy patients tolerate this well. For patients with heart disease, lung disease, glaucoma, or a high body weight, however, it is a genuine source of anaesthetic risk, and some are told that robotic surgery is not possible for them. Single port surgery is performed with the patient lying almost flat, which removes this problem. For these patients, single port can be the difference between having robotic surgery and not having it.
5. Previous abdominal surgery is not an obstacle
Men who have had earlier operations in the abdomen — hernia repairs, bowel surgery, appendectomy — often have internal scar tissue (adhesions) that makes entering the abdominal cavity difficult and risky. Because the extraperitoneal single port route stays outside that cavity, old adhesions are simply bypassed. This group of patients benefits particularly clearly.
6. One small scar
The cosmetic result is a single incision of about 2.5 centimetres low on the abdomen, which fades to a short line. For many men this is a minor point; for some it matters. It is worth mentioning, but it is not the reason to choose single port.
7. A faster return to normal life
Taken together — less pain, no bowel disturbance, a short stay — the result is that most patients return to desk work, driving and light activity within one to two weeks, somewhat earlier than after multi-port surgery. Heavy lifting and vigorous exercise still wait for about six weeks, as the internal healing is the same. A week-by-week picture is given in how long recovery takes after robotic prostate surgery.
What Single Port Does NOT Change
This section matters as much as the one above.
- Cancer control. Current scientific evidence — comparative studies and pooled analyses of single port and multi-port radical prostatectomy — shows no difference in the rate of cancer left at the surgical margin or in early cancer recurrence. The quality of the cancer operation depends on the surgeon, not on the number of ports.
- Urinary control. Recovery of continence over the first year is similar with both systems. Early continence may be slightly faster after single port surgery in some series, but the long-term outcome is the same.
- Erectile function. Nerve-sparing surgery is performed in exactly the same way through the single port system. Whether nerves can be spared depends on the cancer, not on the robot. (See also will I lose sexual function after prostate surgery?)
- Serious complications. Rates of major complications are similar with both systems in experienced hands.
- Operating time. Once a surgeon is experienced with the single port system, operating times are comparable.
In short: single port surgery improves the experience of the operation, not its result. Anyone who tells you otherwise is overstating the evidence.
Who Gains Most from Single Port Prostate Surgery?
| Situation | Why single port matters |
|---|---|
| Previous abdominal surgery or hernia repair | The abdomen is not entered; adhesions are bypassed |
| Heart or lung disease, glaucoma, high body weight | No head-down position; lower anaesthetic risk |
| Low- or intermediate-risk cancer, normal-sized prostate | Same cancer result, gentler recovery |
| Patients travelling from abroad, or with demanding work | Shorter, more predictable stay and recovery |
When Multi-Port Remains the Better Choice
- High-risk cancer requiring extended lymph node removal, where the wider access of the multi-port system is an advantage.
- A very large prostate, where the confined single port working space becomes limiting.
- Cancer that has clearly spread beyond the prostate capsule, where a wider operation is needed.
A surgeon who uses both systems will tell you which applies to you. The question to ask is not “do you do single port?” but “which system do you recommend for me, and why?” The two platforms are compared in more detail in single port vs multi-port robotic prostatectomy.
How We Decide
Before any recommendation we review the MRI, the biopsy report and the PSA history in detail, together with the patient’s medical history and previous operations. Both robotic systems are available in our practice. The patient receives a written explanation of which system we recommend and the reasons for it. For international patients this review is completed remotely before any travel is planned.
Frequently Asked Questions
Is single port surgery new and therefore riskier?
The single port system has been in clinical use since 2018 and has been studied extensively for prostatectomy. In experienced hands its safety profile matches that of multi-port surgery.
Will my cancer be removed as completely?
Yes. Cancer control depends on the surgeon’s technique and experience, which are the same with both systems.
Will I need a catheter?
Yes, as with any radical prostatectomy. The catheter typically stays for five to seven days. Some single port techniques allow a shorter catheter time; this is decided individually.
Can I have nerve-sparing surgery with single port?
Yes. Nerve-sparing depends on the stage and location of the cancer, not on the robotic system.
I have had hernia surgery with mesh. Can I still have single port surgery?
Often, yes. The extraperitoneal route can usually work around previous mesh; this is confirmed on review of your history and imaging.
How do I find out whether single port is right for me?
Send us your MRI, biopsy report and PSA results. You will receive a written assessment within two business days.
Send Your Scans for Assessment
If you have been diagnosed with prostate cancer and would like to know whether single port robotic surgery is appropriate for you, you can send your imaging and reports for a preliminary review. We reply with a written assessment of your options and the next steps. 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.
