## 5 Single-Port vs. Multi-Port Approaches in Robot-Assisted
### The Emergence of Single-Port Robotic Surgery  
The emergence of the da Vinci SP platform marks a significant evolution in robotic surgery, introducing a compact system that operates through a single 2.5 cm multichannel port housing three articulating instruments and a flexible 3D endoscope. This design minimizes incisional morbidity, improves cosmesis, and facilitates access to deep pelvic and retroperitoneal spaces. Early multi-institutional experiences have confirmed the feasibility and safety of SP procedures, including radical prostatectomy (SP-RARP), partial nephrectomy (SP-RAPN), and radical cystectomy, although the current evidence largely stems from retrospective or single-arm series [36; 37; 38]. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Feature** & **Single-Port (SP)** & **Multi-Port (MP)** \\ \hline Number of Ports & 1 multichannel port & 3–5 separate ports \\ \hline Incision Size & \(\approx\)25 mm & 8–12 mm each \\ \hline Instrument Triangulation & Limited & Excellent \\ \hline Learning Curve & Steeper & Shorter \\ \hline Access to Confined Spaces & Superior & Challenging \\ \hline Pain and Recovery & Improved & Moderate \\ \hline Lymph Node Yield & Often Lower & Higher \\ \hline Instrument Strength/Traction & Reduced & Stronger \\ \hline Same-Day Discharge Rate & Higher & Lower \\ \hline Availability & Limited Globally & Widely Available \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Comparative Features of Single-Port (SP) and Multi-Port (MP) Robotic Platforms. In radical prostatectomy, SP-RARP has been successfully performed using transperitoneal, extraperitoneal, and transvesical approaches. Outcomes appear comparable to multi-port RARP (MP-RARP), with reports of reduced postoperative opioid use, shorter hospital stays, excellent cosmetic satisfaction, and similar recovery of continence and erectile function at 3 months [39; 40; 41; 42]. One large series also noted a higher rate of outpatient surgeries in the SP-RARP group, reflecting improved recovery profiles [43]. Studies such as those by [PERSON] et al., [PERSON] et al., and [PERSON] et al. confirm equivalent oncologic and functional outcomes, including continence and complication rates, while SP techniques may result in decreased opioid consumption [44; 45; 46]. However, technical drawbacks, such as reduced triangulation and the absence of a fourth robotic arm, can hinder lymph node dissection or complex reconstruction efforts [47]. For partial nephrectomy, SP-RAPN is feasible in carefully selected patients, typically those with exophytic, low-complexity, or polar tumors. Warm ischemia times and renal function preservation are on par with MP-RAPN, though challenges remain with instrument triangulation, intracorporeal suturing, and assistant access [48; 49]. Meta-analyses suggest reduced postoperative pain and better cosmetic outcomes with SP platforms, but operative times may be longer, and the learning curve steeper [48]. Importantly, complication and conversion rates appear similar between SP and MP approaches in various studies [50]. SP radical cystectomy with intracorporeal diversion has also been performed in limited series, demonstrating encouraging early outcomes [51]. However, the technical demands of complex reconstruction through a single port have limited widespread adoption. Similarly, procedures such as ureteral reimplantation and simple prostatectomy have been shown to be feasible using SP systems, with comparable outcomes to MP techniques when performed by experienced surgeons [52; 53]. The strengths of SP platforms include reduced pain, superior cosmsis, a smaller surgical footprint ideal for narrow anatomical spaces, and the potential for future natural orifice transluminal endoscopic surgery (NOTES). Several series have reported shorter hospital stays and decreased opioid requirements [40].