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Page 6 of 10 Ditonno et al. Mini-invasive Surg 2023;7:36 https://dx.doi.org/10.20517/2574-1225.2023.62

[16]
had a positive surgical margin (PSM) .

Another retrospective analysis of 30 patients undergoing SP RAPN either by transperitoneal or
retroperitoneal approach led to similar results. In this case series, patients were younger [mean (SD) age
50.1 ± 11.9 years], and small low complexity tumors were treated [mean (SD) dimension: 2.1 ± 0.9 cm;
R.E.N.A.L. score 4.27 ± 0.4]. Similar outcomes were achieved in this population [mean (SD) OT: 108 ±
43.1 min; mean (SD) WIT 11.5 ± 7.3 min; mean (SD) EBL 136.3 ± 134.4 min]. Only one patient suffered
from an early post-operative complication (triglycerides in the drainage tube), treated conservatively, and
no post-operative bleeding events were reported. A mean (SD) LoS of 4.1 ± 1.0 days was reported, but it is
important to consider the influence on time to discharge of health policies within the Korean health system
when comparing these results to patients in the United States. No significant difference was observed when
comparing transperitoneal to retroperitoneal approaches. As for post-operative outcomes, no PSM on the
final pathology report and no significant decrease in post-operative renal function were observed, regardless
[13]
of the surgical technique .

Francavilla et al. analyzed 14 consecutive patients undergoing SP transperitoneal RAPN in a retrospective
manner. The median age was 54.5 years (IQR, 48.0-71.0), and all the renal masses were ≤ 4 cm, with a
median R.E.N.A.L. score of six points (IQR, 5.3-7). In this cohort, median OT was 202 min (IQR, 162-231),
WIT 18 min (IQR, 15-24), and EBL 50 mL (IQR, 43-225). One intraoperative (Mild liver capsule injury) and
two post-operative (retroperitoneal hematomas treated with selective embolization, Clavien IIIa)
complications were observed. Nevertheless, the median LoS was 1 (IQR, 1-2), and the median pain score at
discharge was 0 (0-4). From an oncological perspective, PSM was reported in one patient (7%), but no sign
of recurrence was encountered after five months of follow-up . Data from available literature are
[10]
summarized in Table 1.

DIFFERENCES BETWEEN SINGLE PORT AND MULTI-PORT RAPN
The widespread use of the MP robotic platform imposes a comparison in terms of surgical features and
peri-operative outcomes between this and the more innovative SP system for what concerns NSS. A
prospective multicentre cohort study was conducted on the Single Port Advanced Research Consortium
(SPARC) database to assess and compare outcomes of SP and MP RAPN. A total of 1,726 patients
undergoing RAPN at nine institutions in the United States between 2015 and 2021 were included. After
propensity score matching, the two subgroups were similar in terms of mean (SD) age (58 ± 12 years vs. 59 ±
12 years; P = 0.6), mean (SD) tumor size (2.94 ± 1.34 cm vs. 2.96 ± 1.61 cm; P = 0.9), and median R.E.N.A.L
score [6 (IQR: 5-8) vs. 6 (IQR: 5-8); P = 0.8]. SP surgery had longer mean (SD) ischemia time (18.29 ±
10.4 min vs. 13.79 ± 6.29 min; P < 0.01) but no difference in mean (SD) EBL (89.38 ± 111.19 mL vs. 112.46 ±
157.29 mL; P = 0.1) and mean (SD) OT (137.0 ± 59.5 min vs. 142.3 ± 60.6 min; P = 0.4). With regards to
post-operative surgical outcomes, mean (SD) LoS (1.19 ± 1.9 days vs. 1.33 ± 1.0 days; P = 0.4) and rate of
complications of any grade (8.2% vs. 6.1%; P = 0.2) were similar between SP and MP RAPN. No significant
difference was observed in terms of oncological outcomes since the PSM rate (6.1% vs. 4.7%; P = 0.2) was
comparable in the two groups. The authors stratified the entire cohort by tumor complexity, reporting a
longer WIT in the low (16.31-11.08 min vs. 11.61-5.23 min; P = 0.002) and intermediate complexity groups
(19.12-9.18 min vs. 15.32-6.26 min; P = 0.019) for the SP approach. On the contrary, OT for high complexity
SP RAPN was shorter (108.27-39.09 vs. 167.71-55.5 min) than MP RAPN. Other perioperative outcomes
were comparable between the two approaches despite the tumor complexity .
[17]

A systematic review and meta-analysis by Li et al. assessed the available comparative studies between SP
RAPN and MP RAPN. The two groups were homogeneous since no significant difference was observed in
terms of baseline characteristics (age, P = 0.71; tumor diameter, P = 0.34; RENAL score, P = 0.29). No