Feasibility and Early Outcomes of Single-Port Robot-Assisted Partial Nephrectomy via Supine Low Anterior Access

Introduction: We aimed to evaluate the feasibility, safety, and perioperative outcomes of single-port (SP) robot-assisted partial nephrectomy (RAPN) via the supine low anterior access (LAA) compared with conventional multi-port (MP) RAPN. Methods: We retrospectively reviewed 65 patients with cT1a renal tumors who underwent retroperitoneal RAPN between October 2023 and September 2025. Fifteen patients underwent SP-RAPN via the supine LAA, and 50 patients underwent MP-RAPN via the lateral flank access (LFA). Perioperative outcomes and postoperative outcomes, including warm ischemia time (WIT), estimated blood loss (EBL), complications, trifecta achievement, renal function, and length of hospital stay, were compared between the two groups. Results: After adjusting patient variables by 1:2 propensity score matching (PSM), 13 and 26 patients were in the respective groups, and there were no significant differences in baseline characteristics between groups. SP-RAPN demonstrated longer WIT (17.4 ± 3.2 vs. 13.7 ± 3.7 min, p = 0.004). EBL (95 ± 86.1 vs. 63.1 ± 89.3 mL, p = 0.295) and complication rates were similar, with no conversions or positive surgical margins in either group. Length of hospital stay was shorter in the SP group (7.3 ± 0.9 vs. 8.5 ± 0.9 days, p = 0.001). Trifecta achievement was 100% in SP-RAPN vs. 96.2% in MP-RAPN (p = 1). Postoperative renal function was comparable between the two groups. Conclusion: SP-RAPN via the supine LAA is a safe alternative to MP-RAPN, offering comparable oncologic outcomes with reduced hospitalization. Despite longer WIT during the learning phase, the supine LAA and single-port access may provide ergonomic and recovery benefits. However, further studies are warranted to assess its clinical benefits, cost-effectiveness, and long-term oncologic outcomes.