Introduction: Our goal is to evaluate and compare perioperative outcomes of the novel single-port approach assisted by the da Vinci SP (SP) to the multiport approach assisted by the da Vinci Xi (MP) in multiple categories of minimally invasive urologic surgeries.
Methods: Perioperative outcomes for 226 MP cases (132 radical prostatectomies, 60 nephrectomies, and 34 reconstructive surgeries) were compared to 170 SP cases (89 radical prostatectomies, 60 nephrectomies, and 21 reconstructive surgeries). An overall analysis was completed by comparing all available SP cases with a subset of the MP cases that maintained the same number and proportion of the three surgical categories. Eventually each subgroup of procedures has been compared as well. A Z- score test of two populations and associated p-score was calculated to compare rate data while all other outcomes were analyzed using an unpaired t-test.
Results: The overall analysis yielded reductions in postoperative complications (p = 0.001), POD 0 pain scores (p = 0.03), and postoperative hospitalization stays (p < 0.0001) with the SP approach. SP radical prostatectomy cases demonstrated a lower POD 0 pain score (p = 0.004) than MP radical prostatectomy cases and required fewer postoperative hospitalization days (p < 0.0001) despite an older patient population (p = 0.01). SP nephrectomy cases resulted in a lower postoperative complication rate (p = 0.001) and required fewer postoperative hospitalization days (p = 0.005) than MP nephrectomy counterparts. SP reconstructive cases exhibited a lower mean estimated blood loss (p = 0.04) and a significantly lower postoperative complication rate (p = 0.0005) than MP reconstructive surgery counterparts.
Conclusions: In this study, the single-port approach assisted by the da Vinci SP yielded benefits across all studied categories of urologic surgery including the overall analysis. Postoperative complication rates and postoperative hospitalization lengths consistently improved after adoption of the da Vinci SP as evidenced by significant results in multiple surgical categories. Estimated blood loss and POD 0 pain scores exhibited single-port advantages within a single surgical category.