Single-port robotic surgery: the next generation of minimally invasive urology

  • Ryan W. Dobbs
  • Whitney R. Halgrimson
  • Susan Talamini
  • Hari T. Vigneswaran
  • Jessica O. Wilson
  • Simone CrivellaroEmail author
Topic Paper



The da Vinci Single-Port (SP) platform (Intuitive Surgical Inc, Sunnyvale CA) is a recently approved robotic surgical platform which features several novel modifications from previously available single trocar models including a flexible camera, articulating instruments, and navigator guidance for real-time monitoring of instrument position. We sought to describe our clinical experience with this device as well as to review the current literature related to the use of the SP platform.


We provide a narrative review of clinical data related to single-port robotic surgery within the field of urology. In addition, we report our initial clinical experience for surgical procedures performed with the SP platform between December 2018 and April 2019 following installation of the system at our institution.


Currently, the presently available literature for single-port robotic urological surgery consists of single-center case reports and series. Most major robotic urologic operations appear technically feasible using the da Vinci SP platform; however, additional multi-center studies and randomized trials are needed to determine what role the SP platform will play.


Rather than an iterative step or a niche system, the SP platform provides for a new approach to single-site laparoscopic or robotic techniques and is demonstrated as a feasible approach for several major robotic urological operations. While comparative studies will be required to evaluate perioperative and long-term outcomes between SP and multi-port platforms, further technological advances will continue to push surgeons towards less morbid and more minimally invasive approaches for surgery.


Robotics Minimally invasive surgery Prostatectomy Nephrectomy 




Compliance with ethical standards

Conflict of interest

Dr. Crivellaro is a consultant for Intuitive Surgical.


  1. 1.
    McDougall EM, Clayman RV (1994) Advances in laparoscopic urology, Part I. History and development of procedures. Urology 43(4):420–426CrossRefPubMedGoogle Scholar
  2. 2.
    Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, Roemer FD, Pingleton ED, Thomson PG, Long SR (1991) Laparoscopic nephrectomy: initial case report. J Urol 146(2):278–282. CrossRefPubMedGoogle Scholar
  3. 3.
    Guillonneau B, Vallancien G (2000) Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 163(2):418–422. CrossRefPubMedGoogle Scholar
  4. 4.
    Kaouk JH, Haber GP, Goel RK, Desai MM, Aron M, Rackley RR, Moore C, Gill IS (2008) Single-port laparoscopic surgery in urology: initial experience. Urology 71(1):3–6. CrossRefPubMedGoogle Scholar
  5. 5.
    Rane A, Rao P, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology 72(2):260–263. (discussion 263-4) CrossRefPubMedGoogle Scholar
  6. 6.
    Dobbs RW, Magnan BP, Abhyankar N, Hemal AK, Challacombe B, Hu J, Dasgupta P, Porpiglia F, Crivellaro S (2017) Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense? Minerva Urol Nefrol 69(4):313–323. CrossRefPubMedGoogle Scholar
  7. 7.
    Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87(4):408–410CrossRefPubMedGoogle Scholar
  8. 8.
    Dobbs RW, Sofer L, Crivellaro S (2017) Starting a robotic surgery program. In: Rané A et al (eds) Practical tips in urology. Springer, London, pp 513–524CrossRefGoogle Scholar
  9. 9.
    Leow JJ, Chang SL, Meyer CP, Wang Y, Hanske J, Sammon JD, Cole AP, Preston MA, Dasgupta P, Menon M, Chung BI, Trinh QD (2016) Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol. CrossRefPubMedGoogle Scholar
  10. 10.
    Kaouk JH, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A (2014) A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 66(6):1033–1043. CrossRefPubMedGoogle Scholar
  11. 11.
    Kaouk J, Garisto J, Bertolo R (2019) Robotic urologic surgical interventions performed with the single port dedicated platform: first clinical investigation. Eur Urol 75(4):684–691. CrossRefPubMedGoogle Scholar
  12. 12.
    LaMattina JC, Alvarez-Casas J, Lu I, Powell JM, Sultan S, Phelan MW, Barth RN (2018) Robotic-assisted single-port donor nephrectomy using the da Vinci single-site platform. J Surg Res 222:34–38. CrossRefPubMedGoogle Scholar
  13. 13.
    Gaboardi F, Pini G, Suardi N, Montorsi F, Passaretti G, Smelzo S (2019) Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with daVinci Single-Site(R) platform. Concept and evolution of the technique following an IDEAL phase 1. J Robot Surg 13(2):215–226. CrossRefPubMedGoogle Scholar
  14. 14.
    Hebert KJ, Joseph J, Gettman M, Tollefson M, Frank I, Viers BR (2019) Technical considerations of single port ureteroneocystostomy utilizing da Vinci SP platform. Urology. CrossRefPubMedGoogle Scholar
  15. 15.
    Agarwal DK, Sharma V, Toussi A, Viers BR, Tollefson MK, Gettman MT, Frank I (2019) Initial experience with da Vinci single-port robot-assisted radical prostatectomies. Eur Urol. CrossRefPubMedGoogle Scholar
  16. 16.
    Kaouk JH, Bertolo R (2019) Single-site robotic platform in clinical practice: first cases in the USA. Minerva Urol Nefrol 71(3):294–298. CrossRefPubMedGoogle Scholar
  17. 17.
    Garisto J, Bertolo R, Kaouk J (2018) Transperineal approach for intracorporeal ileal conduit urinary diversion using a purpose-built single-port robotic system: step-by-step. Urology 122:179–184. CrossRefPubMedGoogle Scholar
  18. 18.
    Kaouk JH, Garisto J, Eltemamy M, Bertolo R (2019) Robot-assisted surgery for benign distal ureteral strictures: step-by-step technique using the SP((R)) surgical system. BJU Int 123(4):733–739. CrossRefPubMedGoogle Scholar
  19. 19.
    Kaouk JH, Sagalovich D, Garisto J (2018) Robot-assisted transvesical partial prostatectomy using a purpose-built single-port robotic system. BJU Int 122(3):520–524. CrossRefPubMedGoogle Scholar
  20. 20.
    Ramirez D, Maurice MJ, Kaouk JH (2016) Robotic perineal radical prostatectomy and pelvic lymph node dissection using a purpose-built single-port robotic platform. BJU Int 118(5):829–833. CrossRefPubMedGoogle Scholar
  21. 21.
    Maurice MJ, Kaouk JH (2017) Robotic radical perineal cystectomy and extended pelvic lymphadenectomy: initial investigation using a purpose-built single-port robotic system. BJU Int 120(6):881–884. CrossRefPubMedGoogle Scholar
  22. 22.
    Kaouk J, Garisto J, Eltemamy M, Bertolo R (2019) Single-port robotic intracorporeal ileal conduit urinary diversion during radical cystectomy using the SP((R)) surgical system: step-by-step technique. Urology. CrossRefPubMedGoogle Scholar
  23. 23.
    Dobbs RW, Halgrimson WR, Madueke I, Vigneswaran HT, Wilson JO, Crivellaro S (2019) Single port robot-assisted laparoscopic radical prostatectomy: initial experience and technique with the da Vinci SP platform. BJU International. CrossRefPubMedGoogle Scholar
  24. 24.
    Kaouk J, Garisto J, Eltemamy M, Bertolo R (2019) Step-by-step technique for single-port robot-assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci((R)) SP surgical system. BJU Int. CrossRefPubMedGoogle Scholar
  25. 25.
    Kaouk J, Garisto J, Eltemamy M, Bertolo R (2019) Pure single-site robot-assisted partial nephrectomy using the SP surgical system: initial clinical experience. Urology 124:282–285. CrossRefPubMedGoogle Scholar
  26. 26.
    Bertolo RG, Garisto J, Eltemamy M, Kaouk J (2019) Pure single-site trans-perineal robotic radical prostatectomy: first clinical report using the SP® surgical system. Europ Urol Suppl 18(1):e2282. CrossRefGoogle Scholar
  27. 27.
    Kaouk J, Bertolo R, Eltemamy M, Garisto J (2019) Single-port robot-assisted radical prostatectomy: first clinical experience using the SP surgical system. Urology 124:309. CrossRefPubMedGoogle Scholar
  28. 28.
    Barth RN, Phelan MW, Goldschen L, Munivenkatappa RB, Jacobs SC, Bartlett ST, Philosophe B (2013) Single-port donor nephrectomy provides improved patient satisfaction and equivalent outcomes. Ann Surg 257(3):527–533. CrossRefPubMedGoogle Scholar
  29. 29.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. CrossRefGoogle Scholar
  30. 30.
    Sood A, Jeong W, Peabody JO, Hemal AK, Menon M (2014) Robot-assisted radical prostatectomy: inching toward gold standard. Urol Clin North Am 41(4):473–484. CrossRefPubMedGoogle Scholar
  31. 31.
    Talamini S, Halgrimson W, Dobbs R, Crivellaro S (2019) Single port radical prostatectomy versus xi multi-port radical prostatectomy: a human factor analysis. J Urol 201(Supplement 4):e1002–e1003Google Scholar
  32. 32.
    Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32(4):1636–1655. CrossRefPubMedGoogle Scholar
  33. 33.
    Dobbs RW, Pandya S, Abern MR (2017) Robotics and Urologic Surgery. AUA Update Ser 36(22):211–220Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ryan W. Dobbs
    • 1
  • Whitney R. Halgrimson
    • 1
  • Susan Talamini
    • 1
  • Hari T. Vigneswaran
    • 1
  • Jessica O. Wilson
    • 1
  • Simone Crivellaro
    • 2
    Email author
  1. 1.College of MedicineUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of Urology, College of MedicineUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations