Objective: To explore the impact of supine retroperitoneal single-port robot-assisted partial nephrectomy with lower anterior access on perioperative ventilatory, cardiovascular, and pain-related outcomes compared to a cohort of patients treated with single-port robot-assisted retroperitoneal or transperitoneal partial nephrectomy with standard flank patient positioning. Materials and Methods: Clinical and surgical data of all consecutive patients treated with single-port robot-assisted partial nephrectomy between March 2019 and January 2024 were prospectively collected and retrospectively analyzed. Specific same-day-discharge guidelines were applied to all cases. Failed same-day discharge was defined as the presence of early (<90 days) perioperative complications or the absence of opioid-free postoperative recovery. Results: Overall, 105 consecutive patients treated with single-port robot-assisted partial nephrectomy were analyzed. No differences emerged in baseline features. Peak inspiratory pressure and plateau pressure changes were significantly lower in the supine retroperitoneal lower anterior access group from the time of CO₂ insufflation throughout every 30-min operative setpoint assessment (p = 0.02, p = 0.03, and p = 0.02, respectively). The transperitoneal group showed significantly higher values of mean, systolic, and diastolic blood pressure compared to retroperitoneal approaches. The supine lower anterior access group also showed significantly lower non-surgical operative room time, perioperative opioid administration, and postoperative median VAS pain score. Conclusions: The adoption of supine lower anterior access improved perioperative ventilatory, cardiovascular, and pain-related outcomes, also optimizing operating room efficiency. Further multicenter series with longer follow-ups are still needed to validate our preliminary results.

This study aimed to assess early outcomes of the single-port (SP) robotic Low Anterior Access (LAA) for all upper urinary tract surgeries. Additionally, it aimed to explore the impact of clinical factors, notably Body Mass Index (BMI), on post-operative outcomes and length of hospital stay. Overall, 76 consecutive patients underwent SP robotic surgery with LAA involving all upper urinary tract pathologies, with data collected prospectively. Baseline characteristics, intra- and post-operative outcomes, pain levels, and opioid use were analyzed. Statistical methods, including logistic regression and locally weighted scatterplot smoothing (LOWESS) analysis, were used to assess same-day discharge (SDD) predictors and the association between BMI and same-day discharge probability. According to the Institutional Review Board (IRB) protocol, only data recorded in our electronic medical record system were included. Ten different procedures were performed with LAA, with no need for conversion to open surgery and complication rates in line with the literature (30-days: 5%, 90-days: 6.6%). Notably, 77.6% of patients were discharged on the same day. A significant association was found between BMI and prolonged hospital stay, particularly in obese patients (BMI ≥ 30 kg/m2). Post-operative pain was generally low (median VAS: 4), with over 70% discharged without opioid prescriptions. The novel LAA is a versatile approach for various upper urinary tract surgeries, even in obese patients. While achieving satisfactory post-operative outcomes, increased BMI correlated with a reduced likelihood of same-day discharge. Further studies, including larger cohorts and multicenter collaborations, are warranted to explore anesthesiologic management and validate these findings.

Background/Objectives: Single-port radical prostatectomy (SP-RARP) has been demonstrated to be a feasible and safe procedure, even in older patients. This study aims to compare multi-port radical prostatectomy (MP-RARP) with SP-RARP, with a particular focus on elderly patients. Methods: Patients who underwent SP-RARP or MP-RARP between January 2018 and December 2023 were retrospectively analyzed. Patients undergoing concomitant surgical procedures or diagnosed with locally advanced prostate cancer were excluded from this study. Patients were then stratified into two groups: Group A (age < 65 years) and Group B (age ≥ 65 years). Results: A total of 338 patients (153 MP-RARP and 185 SP-RARP) were retrospectively collected. In Group B, the length of stay (in hours) was significantly shorter for SP procedures compared to MP (18 (20.8) vs. 35 (17); p = 0.002), with a higher rate of same-day discharge in favor of SP (45 (54.9%) vs. 9 (16.7%); p < 0.001). Additionally, MP patients in Group B had a higher incidence of postoperative complications at both 30 days (19(35.2%) vs. 13 days (15.9%); p = 0.009) and 90 days (21(38.9%) vs. 14 days (17.1%); p = 0.004) compared to those undergoing SP. Multivariable logistic regression analysis identified SP as a protective factor against postoperative complications at 30 days (Odds ratio: 0.41; 95% CI: 0.15, 0.97; p value = 0.027) and 90 days (Odds ratio: 0.38; 95% CI: 0.17,0.788; p = 0.024). Additionally, length of stay was associated with postoperative complications at 30 days (Odds ratio: 1.02; 95% CI: 1.01, 1.13; p value = 0.046). Conclusions: SP-RARP is a safe and feasible option for elderly patients, offering a lower incidence of short-term postoperative complications compared to MP-RARP. Furthermore, same-day discharge is feasible even in elderly patients undergoing SP-RARP.

Background: The Da Vinci single-port (SP) platform is being used more frequently in radical prostatectomy (RP). In this study we aimed to compare the complications and oncological outcomes of the Da Vinci SP platform in robotic-assisted radical prostatectomy (SP-RARP) between elderly and young age-groups and to further examine differences between young-old and old-old patients. Materials and Methods: Data from 193 patients who underwent SP-RARP between December 2018 and June 2024 were analyzed. Patients were categorized into two age-groups: young (18-64 years) and elderly (65+ years). The elderly group was further divided into young-old (65-69 years) and old-old (70+ years) subgroups. The analysis considered variables related to patient characteristics, intraoperative outcomes, complications, and postoperative oncological outcomes. Results: The median age of the patients at the time of surgery was 64 (9.5) years. The intraoperative complication rate of 1.6%, with no cases requiring conversion to open surgery. The overall incidence of postoperative adverse events was 24.4%, and the 30-day readmission rate was 11.4%. Intraoperative complications and 30-day readmission rates were similar between groups (P = .593 and P = .821, respectively), while the postoperative complication rate was significantly higher in the younger patient group (P = .012). The median length of hospital stay (LOS) was 7 (22) hours and 110 (57%) patients were discharged on the same day (SDD). LOS and SDD rates were similar between groups (P = .389 and P = .529, respectively). The 3-year and 5-year biochemical recurrence (BCR)-free survival rates were 80.5% and 75.1%, respectively. The BCR-free survival rates were similar between both young and elderly patients and between the young-old and old-old groups (P = .751, P = .765, respectively). Conclusion: SP-RARP is a feasible option for elderly patients, delivering acceptable oncological outcomes with a low incidence of postoperative complications.

Purpose: Single-port transvesical robot-assisted simple prostatectomy (SP-SP) is a minimally invasive treatment option for patients with large prostates. However, the impact of prostate volume on perioperative outcomes, particularly in patients with extremely large glands, has not been systematically evaluated. This study aimed to assess the safety and efficacy of SP-SP across different prostate volume strata. Materials and methods: We retrospectively reviewed 90 consecutive patients who underwent SP-SP between 2020 and 2025 by a single surgeon. Patients were stratified by preoperative total prostate volume (TPV) into Group A (80–120 mL, n = 43), Group B (120–160 mL, n = 22), and Group C (>160 mL, n = 25). Perioperative parameters were compared among the three groups. Multivariate logistic regression analysis was performed to identify risk factors for postoperative complications. Results: Baseline characteristics were generally comparable among groups. Pairwise comparisons showed that patients in Group C had significantly higher preoperative PSA levels than those in Group A, as well as longer operative time and greater estimated blood loss (EBL) compared with both Groups A and B. Aside from postoperative hemoglobin levels, recovery and safety outcomes were largely similar across groups. Multivariate analysis identified EBL as the only independent risk factor for postoperative complications, while TPV was not independently associated with complications. Specimen weight increased with increasing prostate volume, while the resection ratio was similar across groups. At the last follow-up, significant improvements were observed in PSA, PVR, IPSS, and QoL scores, as well as in the urinary continence across the three groups, with no significant differences between groups. Conclusions: These findings provide preliminary evidence supporting the feasibility of SP-SP in patients with very large prostates. Larger multicenter studies with adequate sample sizes and longer follow-up are warranted to further evaluate these results.