Introduction: In June 2018, the FDA approved the Intuitive single port (SP) robot for urologic procedures. In January 2019, Hackensack University Medical Center acquired this technology and trained 5 high volume robotic urologic surgeons. This study is designed to evaluate the peri-operative outcomes of SP compared to those of the multiport (MP) robot for procedures of the upper urinary tract to determine the feasibility, safety, and reproducibility of single port robotic surgery.
Methods: Using a prospective IRB database, we compared patients undergoing SP robotic nephrectomy, partial nephrectomy, pyeloplasty, and buccal mucosa ureteroplasty to a 1:1 matched cohort of patients utilizing a MP approach. We used age, sex, BMI, and when appropriate nephrometry score, to create our case matched cohort. Peri-operative outcomes measured included operative time (OR time), warm ischemia time (WIT), estimated blood loss (EBL), Clavien grade greater than 2 complications, positive margin rate, and rate of readmission within 30 days. Due to the 1:1 matching between SP and MP, we treated each analysis as paired data. For the OR comparisons, we performed paired t-tests. For the EBL and LOS comparisons, we performed Wilcoxon signed rank t-tests since these outcomes did not meet normality criteria.
Results: Please see Table 1 for a summary of our results. We found statistically significant differences only in the partial nephrectomy cohort – which included SP having longer OR time (117 vs 91; p<0.022) and WIT (21 vs 8; p< 0.002). EBL was higher for the MP group (130 vs 69; p <0.031).
Conclusions: We compared the peri-operative outcomes of 21 patients undergoing upper urinary tract SP robotic surgery to a 1:1 matched MP cohort. Significant differences were noted in OR time and WIT, which favored the MP group, whereas there was higher EBL in the MP group. These differences may be attributed to the fact that two patients’ surgeries in the MP group were performed off clamp. We conclude that SP surgery is safe, reproducible, and offers minimal to no increase in intra- and peri-operative risks compared to MP robotic surgery for upper urinary tract procedures. Source of