A comparative analysis of perioperative outcomes in single-port and multi-port retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis

Abstract

The retroperitoneal approach for RAPN minimizes interference with intraperitoneal organs but is constrained by a restricted operating space. The single-port (SP) robotic platform excels in navigating tight anatomical environments compared to the multi-port (MP) robotic system. However, there are not many studies that compare the results of surgery using these two platforms when the retroperitoneal approach is used. To address this difference, a detailed review of current studies was done to compare the results of SP-RAPN and MP-RAPN surgeries that were performed using the retroperitoneal method. A comprehensive search was conducted in the databases of PubMed, Web of Science, the Cochrane Library, and SpringerLink to identify any studies that compare urgent-start PD versus urgent-start HD prior to November 25th, 2024. To compare SP-RAPN to MP-RAPN, we looked at things like operation duration, expected blood loss, length of stay, ischemia time, all complications, PSMs, and pathological stage. This meta-analysis incorporated four studies involving a total of 728 patients. Our findings showed no notable distinctions in operative time (WMD - 4.75 min, 95% CI - 12.05 to 2.55, p = 0.20), ischemia time (WMD 3.01 min, 95%CI - 1.32 to 7.34, p = 0.17), blood loss (WMD -3.53 ml, 95% CI - 18.01 to 10.95, p = 0.63), hospital stay duration (WMD - 0.23 days, 95% CI - 0.69 to 0.23, p = 0.32), or overall complication rates (OR 0.34, 95%CI 0.11 to 1.04, p = 0.06) between SP-RAPN and MP-RAPN. Additionally, there was no significant variation in the incidence of positive surgical margins (OR 0.74, 95%CI 0.33 to 1.65, p = 0.46) or in the distribution of postoperative pathological stages, including pT1a (OR 1.22, 95%CI 0.81 to 1.82, p = 0.35), pT1b (OR 0.65, 95%CI 0.39 to 1.06, p = 0.08), and stages ≥ pT2 (OR 1.13, 95%CI 0.54 to 2.38, p = 0.75). While single-port robotic systems provide notable operational advantages in confined spaces, our meta-analysis shows no significant differences between SP-RAPN and MP-RAPN in terms of operative time, intraoperative blood loss, hospital stay, ischemia time, complication rates, and positive surgical margins when both techniques are used for retroperitoneal resection of non-complex renal tumors. Future large-scale randomized controlled trials are required for long-term follow-up to further validate these findings.

Keywords: Multi-port; RAPN; Retroperitoneal; Single-port.