Phd in ADVANCED SURGICAL TECHNOLOGIES

Thesis title: Single-port versus multiport partial nepherectomy: a propensity-score-matched comparison of perioperative and short-term outcomes

Introduction Robot-assisted partial nephrectomy (RAPN) represents the current gold standard for the surgical management of localized renal tumors, offering parenchymal preservation and excellent oncologic and functional outcomes. The introduction of the Da Vinci Single-Port™ (SP) system has enabled complex procedures to be performed through a single incision, reducing surgical trauma and facilitating extraperitoneal approaches. However, comparative evidence between SP-RAPN and the conventional multiport RAPN (MP-RAPN) remains limited. Methods A prospective multicenter study was conducted including 497 patients who underwent RAPN between 2024 and 2025 (369 MP-RAPN; 128 SP-RAPN). After 1:1 propensity score matching, two balanced cohorts of 90 patients each were compared. Demographic, perioperative, functional, and oncologic outcomes were analyzed and compared between groups. In a secondary analysis, limited to the matched cohort, the frequency of “trifecta” achievement was evaluated in relation to the type of robotic platform used. Results The two cohorts were comparable in baseline demographic and clinical characteristics. No significant differences were observed in operative time, estimated blood loss, ischemia time, or perioperative complication rates. The hospital stay was significantly shorter in the SP-RAPN group (median 24 hours vs 33 hours; p < 0.003), suggesting faster postoperative recovery. Rates of positive surgical margins, major complications, and change in estimated glomerular filtration rate at six months (ΔeGFR) were similar between the two groups. The proportion of patients achieving the trifecta was also comparable [SP-RAPN = 57 (63.7%) vs MP-RAPN = 63 (70%); p = 0.7]. Conclusions SP-RAPN demonstrates safety and efficacy comparable to the conventional multiport approach when performed by experienced surgeons. The single-port technique provides additional clinical benefits in terms of postoperative comfort and reduced hospital stay, representing a potential step forward in the adoption of minimally invasive robotic surgery within a day-surgery setting.