Single-port robot-assisted radical prostatectomy is a minimally invasive surgical procedure in which a surgeon removes all of the prostate gland to treat prostate cancer.

The main benefits of single-port robot-assisted radical prostatectomy include less postoperative pain, minimal hospital overnight stays, less scarring, and a quicker recovery compared to traditional open or multiport robotic surgeries. It is performed by inserting a specialized robotic system through a single 1-inch opening, often in the lower abdomen below the belly button. The system includes one camera and three flexible instruments, which the surgeon controls from a separate console. This setup enables precise movements in tight spaces, which is well suited to prostatectomy and other urologic surgeries.

Studies show that single-port robot-assisted radical prostatectomy is a safe and effective option for treating prostate cancer with outcomes similar to multiport surgery and, usually, shorter hospital stays, faster recovery, and less pain.

Single-port robotic surgery is a minimally invasive surgical technique in which a surgeon performs an operation using robotic instruments and a camera that are inserted through a single small incision, rather than multiple incisions. The surgeon uses a console to control the instruments and camera during the procedure. The specialized instruments have flexible joints and are controlled independently, allowing a wide range of motion and precision. Currently, the only FDA-approved robotic system for single port surgery is the da Vinci single-port robotic platform.

Single-port robotic surgery is often used in urology to treat prostate cancer, benign prostatic hyperplasia (BPH), kidney cancer, and various benign kidney disease. Specific procedures include:

• Radical prostatectomy (removal of the entire prostate gland) to treat prostate cancer that has not spread to other parts of the body. The procedure includes removing the prostate and some of the surrounding tissue with the goal of eliminating all cancer cells and reducing the risk of spread.
• Simple prostatectomy (removal of part of the prostate) to relieve symptoms caused by BPH. BPH can press on the urethra, resulting in problems with urination. Surgical removal of the excess (enlarged) prostate tissue helps restore normal urine flow and may improve quality of life.
• Partial nephrectomy: Removal of part of a kidney, often to treat kidney tumors and preserve kidney function
• Radical nephrectomy: Removal of an entire kidney, usually to treat kidney cancer
• Pyeloplasty: Surgical repair of the connection between the kidney and the ureter to treat blockages
• Ureteral reconstruction: Repair of the of the ureter, the tube that carries urine from the kidney to the bladder

Single-port robot-assisted radical prostatectomy is an option for people who need surgical treatment for prostate cancer and who meet certain criteria.

This procedure is typically recommended for individuals with cancer of the prostate that has not spread to other parts of the body. Candidates are usually selected based on the stage of the cancer, prostate size, baseline health, and body-mass index.

Single-port robot-assisted radical prostatectomy can also be a good option for those who have had previous abdominal surgeries, as the single-port approach to the prostate potentially allows for safer access.

Before undergoing single-port robot-assisted radical prostatectomy, patients have a thorough medical evaluation to ensure the procedure is safe and appropriate. This evaluation usually includes a review of medical history, a physical exam, and laboratory tests such as blood work and urinalysis. Imaging studies, such as an ultrasound or magnetic resonance imaging (MRI), may be ordered to assess the size and condition of the prostate and surrounding structures. Finally, additional tests may be performed to confirm that the cancer is confined to the prostate.

Single-port robot-assisted radical prostatectomy is typically performed in an operating room at a hospital or outpatient surgical center while the patient is under general anesthesia, which means the patient will be asleep and will not feel pain during the procedure.

The surgeon uses a specialized robotic system that allows the operation to take place through a single small incision made in the lower abdomen or just above the pubic bone. The incision is about an inch long.

The surgeon places a special access port through the incision. This allows the robotic instruments and a camera to be inserted together. The robotic system includes a high-definition, three-dimensional camera and three flexible, jointed instruments that the surgeon controls from a nearby console.

The surgeon uses the robotic instruments to carefully remove the prostate gland. The camera provides a detailed view of the surgical area. If needed, the surgeon may also remove nearby lymph nodes or perform additional repairs or procedures.

There are several possible approaches for this procedure, including:

• Transvesical approach with the incision near the pubic bones to reach the prostate through the bladder
• Extraperitoneal approach with the incision in the lower abdomen, outside the lining of the abdominal cavity, to access the prostate from the front
• Transperitoneal approach with the incision in the upper abdomen.

The choice of approach depends on the patient’s specific condition, prostate size, and history of previous surgeries.

To remove the prostate, the surgeon must disconnect the gland from the bladder and the urethra (the tube from the bladder that carries urine out of the body). Once the prostate is removed, the surgeon reconnects the bladder to the urethra, and checks for any bleeding. Then, the instruments are removed, and the incision is closed with sutures. The final step is to insert a catheter (a thin tube) into the bladder. This stays in place for about one week after the procedure.

Most patients spend a short time in the hospital—usually about 3 to 5 hours—and many go home the same day as their surgery. After discharge, recovery continues at home.

During the first few days after surgery, patients may experience mild discomfort, swelling, or bruising around the incision site. Pain is usually controlled with less need for strong pain medicine than with other surgical approaches. The urinary catheter will be in place to help drain urine while the area heals. The catheter typically remains in place for one week.

As with most surgical procedures, patients are encouraged to walk and move around as soon as possible to help prevent blood clots and speed up recovery. Most people can return to light activities within a few days, but should avoid heavy lifting, strenuous exercise, and driving until cleared by their doctor.

Full recovery time varies. The care team will monitor progress and provide guidance on when it is safe to resume work, exercise, and other daily routines.

Single-port robot-assisted radical prostatectomy is considered a safe and effective procedure, and complications are not common. However, as with any surgery, there are potential risks and side effects. In most cases, the risks and side effects are similar to or less than other surgical approaches for prostatectomy:

• Bleeding: Some blood loss is expected during surgery, but the risk of needing a blood transfusion is extremely low.
• Infection: There is a small risk of infection at the incision site or in the urinary tract.
• Urinary leakage or incontinence: Some patients may have difficulty controlling urine after surgery.
• Urinary retention: Difficulty emptying the bladder can occur.
• Injury to nearby organs or tissues: Although rare, there is a risk of injury to the bladder, rectum, or blood vessels during surgery.
• Blood clots: As with any surgery, there is a small risk of developing blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) after surgery. Moving around and walking as soon as possible helps reduce this risk.
• Erectile dysfunction: As with other types of prostate surgery, most men experience some difficulty with erections. The risk depends on factors such as age, overall health, and whether nerves around the prostate can be preserved during the procedure.
• Air embolism: Rarely, air can enter the bloodstream during surgery, which may cause symptoms such as low blood pressure or oxygen levels.

Surgical side effects usually improve as the body heals.

Studies show that single-port robot-assisted radical prostatectomy, a minimally invasive approach, offers results similar to or better than traditional open or multiport robotic surgery. Benefits include less pain, reduced blood loss, shorter hospital stays, and a faster recovery. Most patients experience significant improvement in urinary symptoms and quality of life, and the risk of serious complications is low. Simultaneously, early cancer control rates are comparable to other surgical methods when the cancer is confined to the prostate.

Yale New Haven Hospital (YNHH) is the only hospital in Connecticut that has the da Vinci single-port robotic platform.

Yale Medicine urologists are some of the most experienced in this advanced procedure. Dr. Isaac Yi Kim alone, chair of Yale School of Medicine’s Department of Urology, has performed more than 300 single-port robot-assisted radical prostatectomies with successful outcomes.

This article was medically reviewed by Yale Medicine urologist Isaac Yi Kim, MD, PhD, MBA.