Robotic-Assisted Single-Port Radical Prostatectomy: Evaluating the da Vinci SP System

Overview

Robotic-assisted radical prostatectomy via the da Vinci Single-Port (SP) system is a feasible and safe minimally invasive approach for localized prostate cancer. Early evidence indicates benefits such as reduced postoperative pain, shorter hospital stays, and improved cosmetic outcomes, although challenges like a steep learning curve remain.

Background

Prostate cancer is the most commonly diagnosed cancer among men in many countries, with rising incidence attributed to demographic and diagnostic factors. Radical prostatectomy remains a key treatment for localized disease, evolving from open to laparoscopic and robot-assisted techniques to improve outcomes. The da Vinci SP system represents the latest innovation, utilizing a single incision to minimize surgical trauma. This review synthesizes current literature on the SP approach, focusing on perioperative, oncologic, and functional outcomes compared to multiport and traditional methods.

Data Highlights

The review included 99 peer-reviewed articles published between 2018 and 2025, selected from an initial pool of 251 records after rigorous screening and quality appraisal. Data extracted encompassed operative time, blood loss, hospital stay length, complication rates, oncologic margins, continence, and erectile function recovery. Studies varied in surgical approach (extraperitoneal vs transperitoneal) and surgeon experience, with no meta-analysis conducted due to heterogeneity.

Key Findings

• SP-RARP is technically feasible and safe with comparable oncologic outcomes to multiport and open approaches.
• Potential benefits include reduced postoperative pain, shorter hospitalization, and superior cosmetic results due to a single incision.
• Functional outcomes such as urinary continence and erectile function recovery are promising but require further long-term data.
• The learning curve for the da Vinci SP system is steep, with challenges including limited instrument triangulation and maneuverability.
• Use of adjunct tools like EndoWrist SP instruments may mitigate some technical limitations.
• Quality assessment of included studies showed variable methodological rigor but no exclusion based on bias risk.

Clinical Implications

The da Vinci SP system offers a minimally invasive option for radical prostatectomy that may enhance patient recovery and satisfaction. Surgeons should anticipate a learning curve and consider adjunct technologies to optimize outcomes. Careful patient selection and ongoing evaluation of functional and oncologic results are essential to integrate this approach into standard practice.

Conclusion

Robotic-assisted single-port radical prostatectomy via the da Vinci SP system is a promising advancement in urologic oncology, balancing minimally invasive benefits with technical challenges. Continued research and experience will clarify its role relative to established multiport and open techniques.

References

1. Global Cancer Statistics 2020 -- Prostate Cancer Incidence
2. England Cancer Registry 2023 -- Prostate Cancer Trends
3. U.S. Prostate Cancer Disparities -- Incidence and Mortality
4. Laparoscopic Radical Prostatectomy Evolution -- 1990s
5. Robot-Assisted Radical Prostatectomy Introduction -- Early 2000s
6. Functional Outcomes Improvements -- Retzius-Sparing and Nerve-Sparing Techniques
7. Early Studies on da Vinci SP System -- Feasibility and Safety
8. Comparative Outcomes of SP-RARP -- Postoperative Benefits