Single-Port Robotic Retroperitoneal Nephroureterectomy with Bladder Cuff Excision: Comparative Cohort Study with Multi-Port Transperitoneal Approach

Purpose: To investigate the efficacy and safety of single-port (SP) robotic nephroureterectomy (NUx) with bladder cuff excision. Materials and Methods: From September 2021 to August 2024, we reviewed all patients diagnosed with urothelial carcinoma who underwent robot-assisted laparoscopic NUx at our institution since the introduction of the SP robot. Results: A total of 105 patients were included in the study, of whom 52 underwent surgical procedure using the multi-port (MP) approach, whereas 53 underwent surgery using the SP approach. No statistically significant differences were found in patient characteristics, such as gender, body mass index, or tumor size. In terms of surgical outcomes, no statistically significant differences were found in key metrics, such as console time and estimated blood loss. However, a statistically significant difference was observed in total operative time, with an average difference of 45 minutes (222.25 ± 69.38 minutes in MP, 169.98 ± 49.63 minutes in SP, p = 0.000). The estimated blood loss was lower with the SP robot (144.91 mL ± 108.25 in MP, 96.68 ± 72.95 mL in SP, p = 0.004). During the one-year follow-up, no statistically significant differences in renal function loss or T stage were observed. Conclusion: NUx with bladder cuffing using the SP approach demonstrated feasibility compared with surgery performed using the MP approach. Notably, the ease of access during cuffing contributed significantly to reducing the total operative time.