Review

. 2025 Sep 2.

doi: 10.1038/s41585-025-01081-z. Online ahead of print.

The current landscape of single-port robotic surgery in urology

Arianna Biasatti^#^{1

2}, Nicolas A Soputro^#³, Francesco Porpiglia⁴, Sisto Perdonà⁵, Firas Abdollah⁶, Ryan Nelson⁷, Craig Rogers⁶, Lee C Zhao⁸, Ahmed Ghazi⁹, Ben Challacombe¹⁰, Christopher Eden¹¹, Agostino Mattei¹², Christian D Fankhauser¹², Alberto Breda¹³, Bernardo Rocco¹⁴, Francesco Montorsi¹⁵, Alberto Briganti¹⁵, Antony A Pellegrino^{15

16}, Alexandre Mottrie¹⁷, Ruben De Groote¹⁷, Alexander Haese¹⁸, Markus Graefen¹⁸, Marcio C Moschovas¹⁹, Vipul Patel¹⁹, Giuseppe Simone²⁰, Antonio Galfano²¹, Silvia Secco²¹, Riccardo Bertolo²², Savio D Pandolfo^{23

24}, Vito Pansadoro²⁵, Filipe L F Carvalho²⁶, Jean V Joseph²⁷, Mohammad Ramadan²⁸, Jaschar Shakuri-Rad²⁹, Bertram Yuh³⁰, Jeffrey Nix³¹, David I Lee³², Soroush Rais-Bahrami³³, Sij Hemal³⁴, Mohamed Eltemamy³, Alp T Beksac³, Zeyad Schwen³, Li-Ming Su³⁵, Maurizio Buscarini³⁶, Michael Palese³⁶, Ash Tewari³⁶, Peter Wiklund³⁶, Edward E Cherullo¹, Srinivas Vourganti¹, Jennifer A Linehan³⁷, Zhenjie Wu³⁸, Michael Stifelman³⁹, Mutahar Ahmed³⁹, Reza Mehrazin³⁶, Ketan Badani³⁶, Richard E Link⁴⁰, Simone Crivellaro⁴¹, Jihad Kaouk³, Riccardo Autorino⁴²

Affiliations

¹ Department of Urology, Rush University Medical Center, Chicago, IL, USA.
² Urologic Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
³ Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
⁵ Istituto Nazionale Tumori di Napoli, IRCCS "Fondazione G. Pascale", Naples, Italy.
⁶ Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
⁷ Michigan Institute of Urology, Detroit, MI, USA.
⁸ Department of Urology, NYU Langone Health, New York, NY, USA.
⁹ Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA.
¹⁰ Department of Urology, London Bridge Hospital, London, UK.
¹¹ Department of Urology, Royal Surrey County Hospital, Guildford, UK.
¹² Department of Urology, University of Lucerne, Lucerne, Switzerland.
¹³ Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
¹⁴ IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
¹⁵ Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
¹⁶ Italy University Vita-Salute San Raffaele, Milan, Italy.
¹⁷ Department of Urology, Azorg Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium.
¹⁸ Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ AdventHealth Global Robotics Institute, Celebration, USA; University of Central Florida, Orlando, FL, USA.
²⁰ Uro-Oncology Program, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
²¹ Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
²² Department of Urology, University of Verona, A.O.U.I., Verona, Italy.
²³ Department of Urology, University of L'Aquila, L'Aquila, Italy.
²⁴ Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
²⁵ Vincenzo Pansadoro Foundation, Rome, Italy.
²⁶ Department of Urology, Brigham and Women's Hospital, Boston, MA, USA.
²⁷ Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
²⁸ Department of Urology, SSM Health St. Anthony Hospital, Oklahoma City, OK, USA.
²⁹ Department of Urology, Mon Health Medical Center, Morgantown, WV, USA.
³⁰ Department of Urology, City of Hope, Duarte, CA, USA.
³¹ Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
³² Department of Urology, University of California Irvine, Irvine, CA, USA.
³³ Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
³⁴ USC Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
³⁵ Department of Urology, University of Florida, Gainesville, FL, USA.
³⁶ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁷ Department of Urology and Urologic Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
³⁸ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
³⁹ Department of Urology, Hackensack Meridien Health, Hackensack, NJ, USA.
⁴⁰ Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
⁴¹ Department of Urology, University of Illinois at Chicago Health, Chicago, IL, USA.
⁴² Department of Urology, Rush University Medical Center, Chicago, IL, USA. ricautor@gmail.com.

^# Contributed equally.

PMID: 40897917
DOI: 10.1038/s41585-025-01081-z

Review

The current landscape of single-port robotic surgery in urology

Arianna Biasatti et al. Nat Rev Urol. 2025.

. 2025 Sep 2.

doi: 10.1038/s41585-025-01081-z. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, Rush University Medical Center, Chicago, IL, USA.
² Urologic Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
³ Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
⁵ Istituto Nazionale Tumori di Napoli, IRCCS "Fondazione G. Pascale", Naples, Italy.
⁶ Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
⁷ Michigan Institute of Urology, Detroit, MI, USA.
⁸ Department of Urology, NYU Langone Health, New York, NY, USA.
⁹ Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA.
¹⁰ Department of Urology, London Bridge Hospital, London, UK.
¹¹ Department of Urology, Royal Surrey County Hospital, Guildford, UK.
¹² Department of Urology, University of Lucerne, Lucerne, Switzerland.
¹³ Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
¹⁴ IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
¹⁵ Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
¹⁶ Italy University Vita-Salute San Raffaele, Milan, Italy.
¹⁷ Department of Urology, Azorg Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium.
¹⁸ Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ AdventHealth Global Robotics Institute, Celebration, USA; University of Central Florida, Orlando, FL, USA.
²⁰ Uro-Oncology Program, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
²¹ Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
²² Department of Urology, University of Verona, A.O.U.I., Verona, Italy.
²³ Department of Urology, University of L'Aquila, L'Aquila, Italy.
²⁴ Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
²⁵ Vincenzo Pansadoro Foundation, Rome, Italy.
²⁶ Department of Urology, Brigham and Women's Hospital, Boston, MA, USA.
²⁷ Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
²⁸ Department of Urology, SSM Health St. Anthony Hospital, Oklahoma City, OK, USA.
²⁹ Department of Urology, Mon Health Medical Center, Morgantown, WV, USA.
³⁰ Department of Urology, City of Hope, Duarte, CA, USA.
³¹ Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
³² Department of Urology, University of California Irvine, Irvine, CA, USA.
³³ Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
³⁴ USC Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.
³⁵ Department of Urology, University of Florida, Gainesville, FL, USA.
³⁶ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁷ Department of Urology and Urologic Oncology, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA.
³⁸ Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
³⁹ Department of Urology, Hackensack Meridien Health, Hackensack, NJ, USA.
⁴⁰ Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
⁴¹ Department of Urology, University of Illinois at Chicago Health, Chicago, IL, USA.
⁴² Department of Urology, Rush University Medical Center, Chicago, IL, USA. ricautor@gmail.com.

^# Contributed equally.

PMID: 40897917
DOI: 10.1038/s41585-025-01081-z

Abstract

The advent of the purpose-built da Vinci single-port robotic platform marks a pivotal advancement in minimally invasive urological surgery. Designed to overcome the ergonomic and technical limitations of prior single-site approaches, the single-port system enables complex procedures through a single incision, with enhanced dexterity, optimized use of confined spaces and improved cosmetic and peri-operative outcomes. The single-port system has been increasingly used across a wide range of urological indications, including robot-assisted radical prostatectomy, partial nephrectomy, nephroureterectomy and reconstructive surgeries such as pyeloplasty and ureteral re-implantation. Innovative access strategies, such as the single-port transvesical and low anterior access approaches, have facilitated regionalized and multi-quadrant surgeries without the need for repositioning or robot re-docking. These advances have translated into reduced morbidity, faster recovery and increased feasibility of opioid-sparing, same-day discharge protocols. As surgical expertise deepens and technology evolves, the single-port robotic platform stands as a refinement of minimally invasive surgery, and also as a potential paradigm shift in urological practice.

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Conflict of interest statement

Competing interests: R.N. is a proctor for Intuitive surgical and a consultant for Fortec medical and Lexion. A. Ghazi has a research grant with Intuitive. A. Mattei is the CEO of Orsi Academy and adviser of Medtronic, Conmed, Microport, Medicaroid, Intuitive and Samantree. M.R. is consultant and proctor for Intuitive. J.S.R. is consultant and proctor for Intuitive. S.R.B. received research funding from Blue Earth Diagnostics and Progenics/Lantheus and is consultant for Intuitive Surgical and GE Healthcare. J.A.L. was a speaker for Intuitive surgical and is on the scientific advisory board of Medtronic. M.S. is on the Intuitive advisory board of VTI. M.A. is a consultant for Intuitive surgical, VTI, Ethicon and BioTissue. R.E.L. is a consultant and proctor for Intuitive. S.C. is a consultant and proctor for Intuitive. J.K. is a consultant for Intuitive, Endoquest, VTI and is on the advisory board of Method AI. R.A. is a consultant and proctor for Intuitive and is on the advisory board of Method AI. The other authors declare no competing interests.

References

1. Autorino, R. & Porpiglia, F. Robotic surgery in urology: the way forward. World J. Urol. 38, 809–811 (2020). - PubMed - DOI
1. Bignante, G. et al. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert. Rev. Med. Devices 21, 1165–1177 (2024). - PubMed - DOI
1. Kaouk, J. H. et al. A novel robotic system for single-port urologic surgery: first clinical investigation. Eur. Urol. 66, 1033–1043 (2014). - PubMed - DOI
1. Kaouk, J. H. et al. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur. Urol. 60, 998–1005 (2011). - PubMed - DOI
1. Sorokin, I. et al. The decline of laparoendoscopic single-site surgery: a survey of the endourological society to identify shortcomings and guidance for future directions. J. Endourol. 31, 1049–1055 (2017). - PubMed - DOI

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The current landscape of single-port robotic surgery in urology

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The current landscape of single-port robotic surgery in urology

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