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.

Background/Objectives: To compare perioperative, pathological, functional, and oncological outcomes of robot-assisted radical nephrectomy with inferior vena cava tumor thrombectomy (RARN-TT) versus open (ORN-TT) and laparoscopic (LRN-TT) approaches. Methods: PubMed, Scopus, and Web of Science were searched for studies of adults with renal cell carcinoma and Mayo/Neves level I–IV inferior vena cava tumor thrombus undergoing RARN-TT versus ORN-TT and/or LRN-TT. Risk ratios and mean differences with 95% confidence intervals were calculated using random effects models with restricted maximum-likelihood estimation. Results: Eight retrospective studies including 1781 patients were included: 221 underwent robotic surgery, 1411 open surgery, and 149 laparoscopic surgery. Compared with ORN-TT, RARN-TT was associated with lower estimated blood loss (mean difference −900.5 mL, 95% confidence interval −1234.0 to −566.9; p = 0.001), lower transfusion probability (risk ratio 0.395, 95% confidence interval 0.159–0.979; p = 0.046), and shorter hospital stay (mean difference −3.79 days, 95% confidence interval −4.83 to −2.76; p < 0.001). No significant differences were observed in operative time, intensive care unit stay, postoperative complications, perioperative mortality, pathological outcomes, or overall survival. Evidence for cancer-specific and progression-free survival was limited. Comparisons with LRN-TT were exploratory. Conclusions: RARN-TT may reduce blood loss, transfusion requirements, and hospital stay compared with ORN-TT, without evidence of worse perioperative, pathological, or survival outcomes. However, all studies were retrospective and affected by selection bias and heterogeneity. RARN-TT may be considered for selected patients at experienced centers, particularly for lower-level thrombi. Prospective multicenter studies stratified by thrombus level are needed.

Introduction: Adrenalectomies are widely regarded as the preferred treatment for adrenal tumors, typically conducted via laparoscopic or robotic transperitoneal approaches. ¹ In contrast, posterior retroperitoneal approaches are less common, largely due to the constrained maneuvering space they offer. Single-port retroperitoneal radical adrenalectomy (SP-RRA) has become increasingly popular for the possibility to combine several advantages, such as reduced postoperative pain, shorter operative durations, decreased blood loss, and shorter hospital stays, ² along with reduced instrument clashes and improved cosmetic results. ³ To overcome the necessity to placing the patient in a full flank position or a prone jackknife posture with hip joint flexion, ⁴ SP-RRA conducted through the innovative lower anterior access approach (LAA) ⁵ emerges as a secure and viable alternative, providing the advantages of the retroperitoneal approach without necessitating challenging patient positioning. Material and Methods: All patients presenting with an adrenal mass detected via CT or MRI scan who underwent SP-RRA using the LAA approach at our institution between October 2022 and January 2024 and with a follow-up of a minimum of 90 days were included in our case series. No exclusion criteria based on patient or lesion features were adopted. Variables in the study encompassed baseline population characteristics (age, sex, body mass index [BMI], and American Society of Anesthesiologists [ASA] score) as well as tumor features (side and size). Additionally, intraoperative outcomes (in-room time, skin-to-skin time, estimated blood loss, and intraoperative complications) and early postoperative results (pathology findings, major postoperative complications classified by the Clavien–Dindo classification, outpatient setting, and postoperative pain score (evaluated via the visual analogue scale [VAS] at discharge) were examined. Results: Analysis of our initial case series comprised eight patients who underwent SP-RRA with the LAA approach. Baseline characteristics revealed a median (IQR) age of 45 (38–58) years, with an equal distribution of 4 (50%) females and 4 (50%) males. The median (IQR) BMI was 28 (25–31) kg/m2 and the ASA score was 3. ^{2 – 3} Tumor sizes ranged from 1.5 to 5.4 cm, with a median (IQR) size of 3.5 (2.4–4.6) cm, with 5 (43%) located on the left side and 3 (37%) on the right. The median (IQR) in-room operative time was 175 (170–191) minutes, and skin-to-skin time was 132 (124–155) minutes, with only one (12.5%) minor intraoperative complication due to peritoneal infraction during LAA access dissection. All patients were discharged on the same day, with a median postoperative pain score of 3.5 on the VAS scale, and no postoperative major complications (Clavien–Dindo ≥3) were recorded. Most masses were benign tumors, predominantly adrenocortical adenomas. Only one patient had malignancy related to metastatic lesions secondary to prostatic cancer. Conclusion: Our experience contributes to the growing field of SP-RRA using the LAA approach for adrenal tumors. The observed outcomes and potential benefits, along with the adaptability of the SP platform, suggest promising implications for its application in adrenal treatment, showing its potential advantages in terms of hospital stay, cosmetic outcomes, postoperative pain, and patient satisfaction while ensuring surgical effectiveness. The main benefits could be attributed to the SP robot design, which requires only a single skin incision, and to the LAA approach, which eliminates the need for lateral patient positioning and the associated postoperative pain. This also facilitates simpler anesthesiologic management. Although the technical surgical steps of adrenalectomy remain the same as in standard approaches, it is important to consider the learning curve and the challenges of operating within a more confined space. Further research involving larger patient cohorts and longitudinal studies is necessary to strengthen the role of SP-RRA. Statements and Declarations: Dr. Crivellaro is a consultant for Intuitive Surgical. The remaining authors have nothing to disclose. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure: . Source of music: Youtube, the music is instrumental music without copyright: . Runtime of video: 8 mins 21 secs. *These authors contributed equally.