Single‑port versus multi‑port robotic-assisted partial nephrectomy: a systematic review and meta-analysis of propensity score-matched cohort studies

The effectiveness of single-port (SP) versus multi-port (MP) robotic-assisted partial nephrectomy (RAPN) has been compared in many studies, but the comparative superiority remains unclear. The purpose of this article is to comprehensively review the existing literature and conduct a more precise comparison of the two surgical methods.

We performed a thorough literature search in PubMed, Web of Science, Embase, and Cochrane CENTRAL databases to identify relevant studies published before April 2026. Eligible studies were strictly screened for inclusion in the subsequent meta-analysis, and their methodological quality was evaluated using the Newcastle–Ottawa Scale. For continuous outcomes, we computed the mean difference (MD) with 95% confidence intervals (CI). For dichotomous variables, the risk ratio (RR) with 95% CI was applied.

A total of six high-quality retrospective investigations were enrolled, involving 1223 patients in total. Of these, 591 (48%) patients underwent single-port surgery, while 632 (52%) patients underwent multi-port surgery. In terms of the surgical outcomes, primary analyses indicated that SP operation was similar to MP operation. SP and MP exhibited no statistically significant differences regarding positive surgical margins, postoperative complications, major postoperative complications, and ΔeGFR at 6 months. Compared with MP, SP has less-estimated blood loss and better pain control in the early postoperative period. Exploratory sensitivity analyses suggested potential advantages of SP in operative time and hospital stay. Subgroup analysis revealed a trend toward shorter warm ischemia time in the MP group compared with the SP group.

SP is safe and comparable to MP in oncological, safety, and short-term renal function outcomes. Primary analyses showed no significant differences in operative time, hospital stay, or warm ischemia time. SP was associated with slightly lower estimated blood loss and early postoperative pain, but these differences were small and clinically minimal. Exploratory post hoc findings suggesting advantages in operative time and hospital stay require confirmation.