Single-Port Robotics
The da Vinci SP system delivers an articulating endoscope and three jointed instruments through a 25 mm cannula. This permits several access strategies, but the incision and operative corridor still depend on target distance, working space, prior surgery, assistant access and the surgeon's experience.[1]
See Platforms & Manufacturers, Reconstructive Applications and Incisions & Closure.
Platform and Docking
SP instruments articulate at an elbow and wrist, enabling triangulation beyond the cannula. Current instruments and access kits differ from the earliest published configurations. Check the actual instrument, cannula, access kit and procedure labeling; “single port” in a paper may instead describe a multiport robot adapted to one incision.[1][2]
Floating docking raises the port or cannula away from the skin within a sealed access arrangement, increasing the available distance for instrument articulation when the target is close. In the original dry-lab study the gel cap sat 8 cm off the skin with a wound protector as the conduit. The wrist and elbow needed at least 5 and 10 cm between cannula tip and target to articulate, and floating docking increased working volume by more than 390% when the target was closer than 10 cm.[3]
SP instruments generally need approximately 10 cm of deployment space beyond the cannula tip to articulate correctly, which is the constraint floating docking is designed to overcome in restricted spaces or thin patients. The instruments are also less rigid than Si/Xi multiport instruments, so they retract heavier tissue poorly and work better pulling tissue than pushing it. The combined working space of the camera and three instruments is comparable to the volume of a softball: the manufacturer states that the single-arm design eliminates external arm-to-arm collisions[1], but internal instrument collisions are common, especially early in a surgeon's experience; the retraction zone is narrower than with a multiport platform, and moving between quadrants generally requires repositioning the whole system rather than a relocation pedal alone.[3]
Toolbox and camera modes
A 2025 video guide summarizes the current SP toolbox. One patient-side arm carries four instrument drives: a 12 × 8 mm articulating camera and three 6 mm double-jointed instruments pass through an entry guide with one oval and three circular lumens. The access port kit combines a wound retractor, a multichannel cannula and an inflatable cap. The small retractor (2.7 to 4 cm incisions) suits smaller specimens such as pyeloplasty or prostatectomy; the large one (2.7 to 7 cm) is chosen when more working space or a larger specimen is expected. Insufflation can run through the access port alone, through an AirSeal placed beside the wound retractor ("side car") or through a separate trocar.[12]
Listed instruments are Cadiere forceps, round tooth retractor, medium-large clip applier, needle driver, fenestrated and Maryland bipolar forceps, monopolar curved scissors, hook and spatula, plus the Remotely Operated Suction Irrigation System (ROSI), a flexible tube with a rigid tip that the console surgeon steers. Extended-range instruments add about 20% wrist articulation and longer forearms (a manufacturer figure of about 57% more workspace), and the Force Bipolar has a strong-grip mode. The custom remote center (CRC) lets the instruments rotate about a fixed point within the body (the remote center of motion); the authors describe less force on the patient's tissues but give no measurement.[12]
Because the camera and instruments share one port, the camera is moved more often than in multiport surgery. Camera Adjust keeps the camera head fixed while the instruments move around it, Camera Control moves the camera independently, and Cobra mode swings it laterally relative to the instruments. Relocation pivots the cannula and arm about the fulcrum toward another quadrant through the same incision. When that is not enough, the bedside assistant can "burp" the robot, moving the instruments farther in or out to change working depth. The assistant still exchanges instruments, applies clips and suctions when ROSI is not in use.[12]
Incision and Corridor Options
| Option | Anatomical concept | Planning limitation |
|---|---|---|
| Periumbilical | Central access, commonly used for transperitoneal reconstruction | Scar concealment is one consideration; reach, adhesions and extraction requirements may favor another site. |
| Mini-Pfannenstiel / low transverse | Low transverse abdominal access described for selected pyeloplasties and pelvic operations | Published pyeloplasty experience included both this and midline access. |
| Midline suprapubic transvesical | A 3 to 3.5 cm suprapubic incision and cystotomy. A GelPOINT mini system is docked in a floating configuration, with the SP port, a 12 mm assistant port and flexible suction through the gel cap. The bladder is insufflated (pneumovesicum) instead of the peritoneum | Requires bladder entry/closure and careful insufflation management. |
| Low anterior access (LAA) | Anterior lower-quadrant entry that can support retroperitoneal or transperitoneal access in selected operations | Descriptions and landmarks vary between published techniques. |
| Supine anterior retroperitoneal access (SARA) | Supine access through a 3 cm incision at McBurney's point (or its left-sided counterpart). The muscles are dissected and the retroperitoneum is developed with a finger before the access port is placed; the psoas, then ureter, lower pole and hilum are identified | Supine positioning avoids some lateral-position demands. |
| Posterior retroperitoneal | Direct access to the retroperitoneum, often in a lateral position | Remains a valid alternative; choice depends on target anatomy, access and expertise. |
| Extraperitoneal pelvic, without bladder entry | Access to pelvic extraperitoneal planes such as the space of Retzius | Distinct from transvesical access. Prior operations can affect either approach. |
What the Evidence Supports
A 2025 systematic review of SP reconstructive urology found only six retrospective comparisons suitable for its pyeloplasty meta-analysis. Single-port pyeloplasty had lower blood loss (SMD -0.45) and a better cosmetic score (one included study), with no significant difference in complications, operative time, success or renal function gain; the shorter stay did not reach significance. Other reconstructions were represented mainly by small series or case reports, and some “single-port” studies used adapted multiport systems. These findings support feasibility while leaving comparative and long-term benefit uncertain.[2]
| Study / actual cohort | What was reported | Appropriate interpretation |
|---|---|---|
| Lenfant 2020: 10 pyeloplasties, six mini-Pfannenstiel and four midline | Mean operative time 166 minutes; median stay 21 hours; all met the study's three-month success definition[4] | — |
| Pellegrino 2023 SARA: 18 operations, including 12 partial nephrectomies | The reported ischemia, tumor/margin and 83% same-day-discharge findings concern the partial-nephrectomy subgroup | One positive margin is one of 12 partial nephrectomies, not one of 18 heterogeneous operations.[5] |
| Cannoletta 2024 LAA comparison: 102 partial nephrectomies | Median stay 10 hours for 34 LAA cases versus 24 hours for 68 standard-access cases | The comparator combined 26 transperitoneal and 42 posterior retroperitoneal cases. This was observational, not a randomized comparison of incisions.[6] |
| Ramos 2024 transvesical simple prostatectomy: 117 cases; 28 completed 12-month follow-up | Median console time 107 minutes; the paper reports 95.8% discharged within 24 hours; persistent improvement in median symptom score and flow rate at one year among the 12-month completers | “Within 24 hours” is not necessarily same-calendar-day discharge. The report also described two suspected gas/air emboli attributed to high insufflation pressures.[7] |
| Kaouk 2021 transvesical radical prostatectomy: 20 patients | 75% continent within 48 hours and 85% within 10 days after catheter removal[8] | — |
| Ramos 2025 transvesical radical prostatectomy: 210 cases | Median blood loss 70 mL and console time two hours; 92% of planned outpatient cases discharged within 24 hours | Keep the outpatient denominator, timing and study-specific endpoints separate from earlier continence results.[9] |
The transvesical simple-prostatectomy series omitted drains and continuous irrigation routinely within that center's protocol. The possibility of gas embolism and other complications requires a coordinated insufflation and anesthesia plan.[7] The initial transvesical simple-prostatectomy series describes keeping bladder (pneumovesical) insufflation pressure at approximately 10 mmHg or less, rather than the higher pressures used transperitoneally, specifically to limit the risk of hypercarbia or venous gas embolism from CO₂ absorbed through the bladder wall.[11]
Cosmesis and Patient Counseling
Raver's 111-patient observational cohort included 54 multiport and 57 SP patients; only 27 had an SP umbilical incision. Adjusted analysis found less scar bother with SP umbilical access versus multiport (OR 0.08, 95% CI 0.01–0.38).[10]
Discuss the intended incision and corridor, the possibility of assistant or additional ports or conversion, catheter expectations and procedure-specific risks. Discharge depends on the operation, patient, local pathway and support at home.
Videos
References
1. Intuitive. Da Vinci SP system and accessories. System information; instrument/accessory catalog.
2. Santarelli V, Valenzi FM, Haberal HB, et al. Current status of single port robotic-assisted reconstructive urology: a systematic review, meta-analysis and structured summary of the available literature. J Robot Surg. 2025;19(1):349. doi:10.1007/s11701-025-02509-9. Full text.
3. Lenfant L, Kim S, Aminsharifi A, Sawczyn G, Kaouk J. Floating docking technique: a simple modification to improve the working space of the instruments during single-port robotic surgery. World J Urol. 2021;39(4):1299-1305. doi:10.1007/s00345-020-03307-8.
4. Lenfant L, Wilson CA, Sawczyn G, et al. Single-port robot-assisted dismembered pyeloplasty with mini-Pfannenstiel or peri-umbilical access: initial experience in a single center. Urology. 2020;143:147–152. doi:10.1016/j.urology.2020.05.041.
5. Pellegrino AA, Chen G, Morgantini L, Calvo RS, Crivellaro S. Simplifying retroperitoneal robotic single-port surgery: novel supine anterior retroperitoneal access. Eur Urol. 2023;84:223–228. doi:10.1016/j.eururo.2023.05.006.
6. Cannoletta D, Pellegrino AA, Pettenuzzo G, et al. Surgical outcomes of novel retroperitoneal low anterior vs posterior and transperitoneal access in single-port partial nephrectomy. World J Urol. 2024;42:387. doi:10.1007/s00345-024-05096-w.
7. Ramos R, Ferguson E, Abou Zeinab M, et al. Single-port transvesical robot-assisted simple prostatectomy: surgical technique and clinical outcomes. Eur Urol. 2024;85:445–456. doi:10.1016/j.eururo.2023.11.012.
8. Kaouk J, Beksac AT, Abou Zeinab M, et al. Single port transvesical robotic radical prostatectomy: initial clinical experience and description of technique. Urology. 2021;155:130–137. doi:10.1016/j.urology.2021.05.022.
9. Ramos R, Soputro N, Pedraza AM, et al. Single port transvesical robot assisted radical prostatectomy. J Endourol. 2025;39(S1):S39–S46. doi:10.1089/end.2024.0291.
10. Raver M, Implicito C, Henrich M, et al. Does incision location matter? Analysis of single-port cosmesis in urologic reconstructive surgery. J Endourol. 2024;38:1364–1371. doi:10.1089/end.2024.0322.
11. Kaouk J, Sawczyn G, Wilson C, et al. Single-Port Percutaneous Transvesical Simple Prostatectomy Using the SP Robotic System: Initial Clinical Experience. Urology. 2020;141:173-177. doi:10.1016/j.urology.2020.02.024.
12. Orsini A, Bignante G, Lasorsa F, et al. Single port robotic platform and toolbox: what is new. Urol Video J. 2025;27:100361. doi:10.1016/j.urolvj.2025.100361