Single-port Robotic Retroperitoneal Partial Nephrectomy via Low Anterior Access: A Propensity-matched Comparative Analysis to Standard Transperitoneal Multiport Robotic Surgery from the Single Port Advanced Research Consortium (SPARC)

Background and objective: The introduction of the purpose-built single-port (SP) robotic platform has paved the way for the development of regionalized surgical approaches, as evident by the advent of low anterior access (LAA) SP retroperitoneal robot-assisted partial nephrectomy (rRAPN). Our aim was to evaluate perioperative outcomes of LAA SP-rRAPN in comparison to the standard transperitoneal multiport (MP) robotic approach. Methods: We performed a retrospective review of the institutional review board–approved, prospectively maintained database of the SP Advanced Research Consortium (SPARC) to identify all consecutive patients who underwent RAPN between 2015 and 2025. We applied 1:1 propensity score matching (PSM) for analysis to ensure comparable baseline characteristics, including comorbidities, renal function, and tumor complexity. Key findings and limitations: Of 2306 patients, our PSM analysis included 302 LAA SP-rRAPN cases and 302 MP-RAPN cases. Following PSM, the two cohorts demonstrated comparable operative time, estimated blood loss, surgical margin status, and incidence of major postoperative complications. A history of abdominal surgery was more common in the SP group (55.1% vs MP 42.7%; p = 0.005). Postoperatively, the SP cohort had significantly shorter hospital stay (<24 h: SP 41.6% vs MP 10.9%; p < 0.001), lower postoperative pain (median highest pain score: SP 5 vs MP 6; p < 0.001), and less frequent need for opioids (SP 46.3% vs MP 93.1%; p < 0.001). Notably, no SP patients experienced postoperative ileus or respiratory complications such as atelectasis, pleural effusion, or pneumonia. Conclusions and clinical implications: This study highlights the safety and efficacy of LAA SP-rRAPN, which has perioperative outcomes comparable to those for the transperitoneal MP robotic approach. Moreover, LAA SP-rRAPN offers additional benefits, including enhanced postoperative recovery with lower morbidity, and provides a viable surgical alternative for patients with complex abdominal surgical history.