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

Table 1. Pre-operative, intra-operative, and post-operative features of SP RAPN
N of Pre-operative Intra-operative Post-operative
Author Year Approach
patients features outcomes outcomes
[6]
Kaouk et al. 2018 3 Transperitoneal Na OT: 180 min Complication rate: 33.3%
WIT: 25 min PSM: 0%
EBL: 180 mL
Shukla et al. [16] 2020 12 Transperitoneal Mean age: 57.8 years Mean OT: 171.6 min Complication rate: 0%
Mean tumor size: 3.1 cm WIT: <25 min Mean LoS: 1.2 days
RENAL score: ≤ 6 (83%) Mean EBL: 68.3 mL PSM: 1%
Bang et al. [13] 2023 30 Transperitoneal and Mean age: 50.1 years Mean OT: 108 min Complication rate: 3%
retroperitoneal Mean tumor size: 2.1 cm Mean WIT: 11.5 min Mean LoS: 4.13 days
Mean RENAL score: 4.27 EBL: 136.3 mL PSM: 0%
Francavilla 2022 14 Transperitoneal Median age: 54.5 years Median OT: 202 min Complication rate: 14%
[10]
et al. Median tumor size: 2.6 cm Median WIT: 18 min Median LoS: 1 day
Median RENAL score: 6 Median EBL: 50 mL PSM: 7%
Pellegrino 2023 12 Retroperitoneal Mean age: 57 years Mean OT: 109 min Complication rate: 8%
et al. [14] Mean tumor size: 3.7 Mean WIT: 25 PSM: 8%
Median RENAL score: 5 Mean EBL: 120 mL Same-day discharge: 83%

EBL: Estimated blood loss; LoS: length of stay; OT: operative time; PSM: positive surgical margin; RAPN: robot-assisted partial nephrectomy; SP:
single port; WIT: warm ischemia time.

significant difference in terms of OT (P = 0.19) was observed when comparing SP RAPN to MP RAPN.
WIT was significantly longer for SP RAPN than for MP RAPN [weight mean difference (WMD) 3.46 min,
95%CI 1.03, 5.90; P < 0.01). On the other hand, EBL was lower in the SP RAPN group (WMD - 27.16 mL,
95%CI - 56.90, 2.58; P = 0.07) without reaching statistical significance. An overall complication rate < 10%
was reported, with no statistical difference in terms of overall complication (SP RAPN 7.3% vs. MP RAPN
8.7%, P = 0.9) intraoperative complications (SP RAPN 0% vs. MP RAPN 2%, P = 0.60) and major
complications (SP RAPN 3.4% vs. MP RAPN 3.7%, P = 0.84). The two approaches also appeared comparable
in terms of oncological outcomes since no difference in the PSM rate was registered (P = 0.9) .
[18]

DISCUSSION
The introduction of the Da Vinci SP® platform represents the latest innovation in the field of minimally
invasive urological surgery, aiming to provide patients with surgical procedures that offer non-inferior
outcomes with respect to traditional surgery, along with advantages in terms of invasiveness, LoS, and post-
operative pain. However, this platform still represents a work in progress, with the aim of overcoming
existing limitations. Some of these limitations have already been addressed, such as instrument strength and
camera movements. However, others, such as the limited availability of dedicated tools, remain unsolved.
We critically reviewed and summarized the available evidence on SP RAPN, comparing them to traditional
MP RAPN. Although many of the included studies are based on preliminary experiences with limited
sample sizes, our study reveals several noteworthy findings.

The surgical quality of a RAPN has been defined by the so-called “Trifecta” outcomes, which has been
defined in several ways, but it is, in general, the concomitant occurrence of short WIT, negative surgical
margins, and no perioperative complications . According to these outcomes, our results highlight how SP
[19]
RAPN represents a safe and feasible option for NSS.