Abstract
Introduction: Single-port robot-assisted partial nephrectomy (SP-RAPN) is an emerging minimally invasive technique for nephron-sparing surgery, offering potential advantages in confined anatomical spaces. While initial data from the USA are promising, European experiences remain sparse. Here, we present early European experiences of transperitoneal (TP) and retroperitoneal (RP) approaches. Methods: We retrospectively analyzed all consecutive patients undergoing SP-RAPN and compared perioperative outcomes of TP and RP approaches. Results: Within the first 15 months after implementation of the SP system, 61 patients underwent SP-RAPN (31 TP, 30 RP) without open conversion. Tumors treated via the TP approach were significantly larger (42 vs. 26 mm, p < 0.001). RP was associated with shorter median operative time (170 vs. 222 min, p = 0.008), lower estimated blood loss (50 vs. 100 mL, p = 0.002), and shorter length of hospital stay (2 vs. 2 days [IQR 2–2 vs. 2–3], p = 0.002), while warm ischemia time was comparable (21 vs. 22 min, p = 0.4). Positive surgical margins (TP 3% case vs. RP 0%, p > 0.9) and postoperative bleeding requiring embolization (TP 1 case 3% vs. RP 0%, p > 0.9) were not significantly different between groups. Besides this one case requiring embolization, no further Clavien-Dindo grade >II complication was observed within 90 days. Conclusion: Within the first 15 months, SP-RAPN showed promising feasibility, safety, and early oncological outcomes using either the TP or RP approach.
