Is Single Port Surgery Right for Me? A Candidate Checklist
By Prof. Dr. Murat Binbay · Professor of Urology · Uro-oncology and Robotic Surgery · Istanbul · Reading time about 8 minutes
Patients often arrive at a consultation having already decided that they want single port surgery. Sometimes they are right. Sometimes the conventional multi-port system would serve them better, and sometimes the honest answer is that either would do. This checklist is designed to help you work out, before you contact any surgeon, which group you are likely to fall into — and which questions only a surgeon can answer after looking at your scans.
It is not a test you pass or fail. It is a way of organising the facts about your disease, your body and your priorities so that the conversation with your surgeon starts in the right place.
How to Use This Checklist
There are three parts. Part 1 is about your disease, Part 2 about your body and general health, Part 3 about what matters most to you. For each question, note which column your answer falls into. At the end, Part 4 explains how to read the pattern of your answers. Keep your most recent MRI report, biopsy report and PSA results beside you; most of the answers are in them.
If you are unsure about any answer, leave it blank. Uncertainty is itself useful information: it tells us what to look at first.
Part 1 of the Checklist — Your Disease
If you have prostate cancer
| Question | Points towards single port | Points towards multi-port | Needs surgeon’s review |
|---|---|---|---|
| What is your Gleason score / grade group? | 3+3 or 3+4 (grade group 1–2) | 4+5, 5+4 or 5+5 (grade group 5) | 4+3 or 4+4 (grade group 3–4) |
| What is your PSA? | Below 10 ng/mL | Above 20 ng/mL | 10–20 ng/mL |
| Does the MRI show the cancer confined to the prostate? | Yes, confined (T1–T2) | Clear spread outside the capsule or into the seminal vesicles (T3) | “Possible” or “suspected” extension |
| Is extended lymph node removal likely to be needed? | No (low risk) | Yes (high risk) | Intermediate risk — depends on nomogram |
| How large is your prostate on MRI? | Below about 60 ml | Above about 100 ml | 60–100 ml |
| Has the cancer been treated before (radiotherapy, focal therapy)? | No | — | Yes: salvage surgery needs individual review |
Why these matter. Single port surgery works in a small, closed space next to the prostate. It is ideal when the operation is confined to the prostate itself and lymph node sampling is limited. When the cancer is high-risk, when wide lymph node removal is needed, or when the prostate is very large, the wider working space of the multi-port system becomes an advantage. Cancer control is the same with both systems when the right system is chosen for the right patient. The difference between the two platforms is explained in single port vs multi-port robotic prostatectomy.
If you have a kidney tumour
| Question | Points towards single port | Points towards multi-port | Needs surgeon’s review |
|---|---|---|---|
| How large is the tumour? | Below 4 cm | Above 7 cm | 4–7 cm |
| Where is it on the kidney? | On the outer surface or back (posterior / lateral) | Deep in the centre, touching the main vessels or collecting system | Front-facing (anterior) or partly central |
| Can the kidney be preserved (partial nephrectomy)? | Yes | Whole kidney must be removed for a very large tumour | Depends on complexity scoring |
| Does the tumour involve the renal vein or vena cava? | No | Yes | — |
Why these matter. The single port system reaches the kidney from the back (the retroperitoneal route), which suits tumours on the back or outer surface of a kidney and avoids the bowel entirely. Very large tumours, tumours involving major vessels, and some front-facing tumours are better served by the multi-port system’s wider access. More detail is given in single-port robotic kidney surgery: what to expect.
If you have another urological condition
Adrenal tumours, ureteropelvic junction obstruction, bladder diverticula and most reconstructive operations are generally well suited to single port surgery. Radical cystectomy for bladder cancer is performed with single port only in selected patients. See our guide to single port procedures in urology for details.
Part 2 of the Checklist — Your Body and General Health
This part is where single port surgery most often makes a decisive difference — and where patients are sometimes wrongly told that robotic surgery is not possible for them.
| Question | Points towards single port | Neutral | Needs surgeon’s review |
|---|---|---|---|
| Have you had previous abdominal surgery (hernia repair, bowel surgery, appendectomy, previous laparoscopy)? | Yes — single port avoids old scar tissue by staying outside the abdominal cavity | No | Extensive surgery in the pelvis itself |
| Do you have a hernia repaired with mesh? | Yes — usually manageable with the extraperitoneal route | No | Bilateral or very large mesh |
| Do you have heart disease, lung disease (COPD, asthma) or sleep apnoea? | Yes — single port avoids the steep head-down position | No | Severe disease: anaesthetic assessment needed first |
| Do you have glaucoma or raised pressure in the eyes? | Yes — avoiding head-down tilt matters | No | — |
| What is your body mass index (BMI)? | Above 30 — flat positioning and no bowel handling help | 20–30 | Above 40 |
| Are you on blood thinners? | — | No | Yes: needs a plan for stopping and restarting |
| Do you have any condition that limits lying flat or tilted for 2–3 hours? | Single port needs much less tilt | No | Yes |
Why these matter. Multi-port surgery enters the abdominal cavity and requires the patient to be tilted steeply head-down. Both of these are safe for most people, but for patients with previous abdominal operations, heart or lung conditions, glaucoma or a high body weight they add real risk. Single port surgery performed through the extraperitoneal or retroperitoneal route avoids both. If you answered “yes” in the left-hand column of this part, you are among the patients who benefit most from single port surgery.
Part 3 of the Checklist — Your Priorities
There is no right or wrong answer here. These questions help us understand what a good outcome looks like for you.
| Question | What it tells us |
|---|---|
| How important is the shortest possible hospital stay? | Single port patients are often discharged the next morning; selected patients the same day |
| How important is minimal use of strong painkillers? | Single port is associated with lower opioid use |
| Are you travelling from abroad with a limited time in Istanbul? | A shorter, more predictable stay favours single port when the disease allows it |
| How important is the appearance of the scar? | Single port leaves one small incision; multi-port leaves five or six |
| Would you accept the multi-port system if it offered a safer or more complete cancer operation in your case? | We hope the answer is yes — this is the question that keeps the decision honest |
Part 4 — Reading Your Checklist Answers
Mostly left-hand column in Parts 1 and 2. You are very likely a good candidate for single port surgery. The decisive factors are usually: cancer confined to the organ, no need for extended lymph node removal, and — especially — previous abdominal surgery, a heart or lung condition, or a high body weight. Send your scans; the review will confirm the route.
Mostly middle column (“points towards multi-port”) in Part 1. Your disease is likely to need the wider access of the multi-port system: extended lymph node removal, a very large prostate, or a large or central kidney tumour. This is not bad news. Multi-port robotic surgery is a mature, excellent operation, and in your case it is the safer choice. A surgeon who uses both systems will explain why.
Several answers in the “needs surgeon’s review” column. This is the most common pattern, and it is exactly what the review is for. Intermediate-risk prostate cancer, a 4–7 cm kidney tumour, a prostate of 60–100 ml, previous pelvic surgery: each of these can go either way, and the decision depends on details that only the MRI and your history reveal.
Mixed answers across the columns. Also common. The disease may favour multi-port while your body favours single port, or the reverse. The surgeon weighs the two. As a rule, disease factors come first — the cancer operation must be complete — and body factors decide between two equally complete options.
What We Check That a Checklist Cannot
A checklist can organise the facts, but four things need a surgeon’s eye:
- The MRI itself, not just the report. Where exactly the tumour sits, how close it is to the nerves, the capsule or the vessels, and how the prostate or kidney is shaped. Two patients with identical reports can need different operations.
- The biopsy map. How many samples contained cancer, where they came from and at what grade. This decides whether nerve-sparing is realistic and whether lymph node removal is needed.
- Your previous operation notes. What exactly was done, and where. A hernia repair with mesh on one side is different from one on both.
- The anaesthetic picture. Heart, lung and airway assessment, which may need a cardiologist or anaesthetist’s opinion before any operation is scheduled.
All of this can be assessed remotely from your scans and reports before you travel. You will receive a written opinion stating which system we recommend and the reasons. You can read more about how patients are selected in SP robotic surgery: clinical advantages and patient selection.
Frequently Asked Questions
I answered mostly “single port”. Does that guarantee single port surgery?
No. It means you are likely to be a good candidate. The final decision follows review of your MRI, biopsy and history.
I answered mostly “multi-port”. Have I lost the advantages of robotic surgery?
No. Multi-port robotic surgery still offers small incisions, precise nerve-sparing and quick recovery compared with open surgery. You have simply been directed to the system that suits your disease.
My local surgeon says I am not suitable for robotic surgery because of my heart condition. Is that final?
Not necessarily. The concern is usually the steep head-down position of multi-port surgery. Single port surgery performed flat may be possible. Send your scans and your cardiology reports for review.
I am over 75. Does age rule out single port surgery?
Age alone does not. General health, fitness for anaesthesia and the nature of the cancer matter far more than the number.
Can I have single port surgery if I have had radiotherapy for prostate cancer?
Salvage surgery after radiotherapy is technically demanding and is assessed individually. It is possible in selected patients but is never decided from a checklist.
What should I send for a review?
Your MRI (images, not just the report), biopsy pathology report, PSA history, a list of previous operations and current medications, and any cardiology or lung reports.
Send Your Scans for Assessment
If you have completed this checklist and would like a written opinion on whether single port robotic surgery is right for you, send your imaging and reports for a preliminary review. We reply within two business days with a written assessment and the next steps. Tel: +90 530 100 90 85
This checklist is for general information only and does not replace an individual medical consultation. Treatment decisions are made after a personal assessment with your surgeon.
