Upper Urinary Tract Surgery through Robotic Single-Port System versus Multi-Port and LESS Systems: a Systematic Review and Meta-Analysis.

PURPOSE: We aimed to make a general comparison between the safety and feasibility of a novel robotic platform, da Vinci® SP system with conventional robotic multi-port (MP) and laparoendoscopic single-site (LESS) systems (da Vinci® Xi or Si) in three upper urinary tract procedures including robot-assisted partial nephrectomy (RAPN), robot-assisted pyeloplasty (RAP) and robotic adrenalectomy (RA).

MATERIALS AND METHODS: After systematically searched the literature up to August 2022 in PubMed®, Web of Science™ and the Cochrane Library and Scopus® database, we extracted and processed the data in eligible literature for operative time, warm ischemia time (WIT), morphine milligram equivalent (MME), postoperative complications and positive surgical margins (PSM).

RESULTS: A total of 738 patients who underwent robotic surgery for SP or MP from 10 articles were included in this meta-analysis. There was no statistically significant difference in operative time for either RAPN (SMD -0.16, 95% CI -0.39 to 0.08) or RA (SMD -0.51, 95% CI -1.08 to 0.06). However, for RALP, SP can save operation time (SMD -0.73, 95% CI -1.24 to -0.22).There was no difference in the incidence of postoperative complications after RAPN (OR 0.81, 95% CI 0.35 to 1.89), nor in the incidence of PSM (OR 1.09, 95% CI 0.49 to 2.41) between the two procedures. It is worth noting that although the SP system increases WIT (SMD 0.45, 95% CI0.27 to 0.63), which may be partly due to the learning curve, the SP has the benefit of reducing intraoperative pain in RAPN in regard of MME (SMD -0.40, 95% CI -0.71 to -0.09).

CONCLUSIONS: Due to issues with SP surgical instruments, such as the need for an additional robotic arm to manipulate the bulldog clamp, SP will increase WIT during RAPN procedure. Surgeons may extend the learning curve to overcome the growing warm ischemic injury.