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  • Review Article
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The current landscape of single-port robotic surgery in urology

Nature Reviews Urology (2025)Cite this article

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Abstract

The advent of the purpose-built da Vinci single-port robotic platform marks a pivotal advancement in minimally invasive urological surgery. Designed to overcome the ergonomic and technical limitations of prior single-site approaches, the single-port system enables complex procedures through a single incision, with enhanced dexterity, optimized use of confined spaces and improved cosmetic and peri-operative outcomes. The single-port system has been increasingly used across a wide range of urological indications, including robot-assisted radical prostatectomy, partial nephrectomy, nephroureterectomy and reconstructive surgeries such as pyeloplasty and ureteral re-implantation. Innovative access strategies, such as the single-port transvesical and low anterior access approaches, have facilitated regionalized and multi-quadrant surgeries without the need for repositioning or robot re-docking. These advances have translated into reduced morbidity, faster recovery and increased feasibility of opioid-sparing, same-day discharge protocols. As surgical expertise deepens and technology evolves, the single-port robotic platform stands as a refinement of minimally invasive surgery, and also as a potential paradigm shift in urological practice.

Key points

  • The single-port robotic platform enables complex urological procedures to be carried out through a single incision, enhancing surgical precision, ergonomics and access to confined spaces while reducing invasiveness.

  • The single-port system has been successfully applied across various urological procedures, including radical prostatectomy, partial nephrectomy, nephroureterectomy and reconstructive surgeries such as pyeloplasty and ureteral re-implantation.

  • Innovative approaches, such as transvesical and retroperitoneal low anterior access, have expanded single-port capabilities, enabling regionalized and multi-quadrant surgeries to be performed without repositioning or robot re-docking.

  • Single-port-related techniques have shown improved peri-operative outcomes, including reduced morbidity, reduced hospital stays and increased potential for opioid-sparing, outpatient recovery protocols.

  • The single-port platform addresses crucial technical limitations of previous single-site approaches, offering improved dexterity, control and surgeon ergonomics in narrow operative fields.

  • With growing clinical experience and ongoing technological development, single-port robotic surgery is positioned as a transformative advancement in minimally invasive urology, with potential to redefine procedural standards.

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Fig. 1: Intraoperative room configuration for single-port robotic surgery.
Fig. 2: Surgical approaches for single-port robot-assisted radical prostatectomy.
Fig. 3: Extra-peritoneal versus transvesical single-port robot-assisted radical prostatectomy.
Fig. 4: Surgical approach for single-port robot-assisted partial nephrectomy.
Fig. 5: Surgical approach for single-port robot-assisted radical nephrectomy.
Fig. 6: Surgical approach for single-port radical cystectomy.

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Author notes

  1. These authors contributed equally: Arianna Biasatti, Nicolas A. Soputro.

Authors and Affiliations

  1. Department of Urology, Rush University Medical Center, Chicago, IL, USA

    Arianna Biasatti, Edward E. Cherullo, Srinivas Vourganti & Riccardo Autorino

  2. Urologic Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy

    Arianna Biasatti

  3. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Nicolas A. Soputro, Mohamed Eltemamy, Alp T. Beksac, Zeyad Schwen & Jihad Kaouk

  4. Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy

    Francesco Porpiglia

  5. Istituto Nazionale Tumori di Napoli, IRCCS “Fondazione G. Pascale”, Naples, Italy

    Sisto Perdonà

  6. Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA

    Firas Abdollah & Craig Rogers

  7. Michigan Institute of Urology, Detroit, MI, USA

    Ryan Nelson

  8. Department of Urology, NYU Langone Health, New York, NY, USA

    Lee C. Zhao

  9. Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA

    Ahmed Ghazi

  10. Department of Urology, London Bridge Hospital, London, UK

    Ben Challacombe

  11. Department of Urology, Royal Surrey County Hospital, Guildford, UK

    Christopher Eden

  12. Department of Urology, University of Lucerne, Lucerne, Switzerland

    Agostino Mattei & Christian D. Fankhauser

  13. Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain

    Alberto Breda

  14. IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy

    Bernardo Rocco

  15. Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy

    Francesco Montorsi, Alberto Briganti & Antony A. Pellegrino

  16. Italy University Vita-Salute San Raffaele, Milan, Italy

    Antony A. Pellegrino

  17. Department of Urology, Azorg Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium

    Alexandre Mottrie & Ruben De Groote

  18. Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Alexander Haese & Markus Graefen

  19. AdventHealth Global Robotics Institute, Celebration, USA; University of Central Florida, Orlando, FL, USA

    Marcio C. Moschovas & Vipul Patel

  20. Uro-Oncology Program, IRCCS “Regina Elena” National Cancer Institute, Rome, Italy

    Giuseppe Simone

  21. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Antonio Galfano & Silvia Secco

  22. Department of Urology, University of Verona, A.O.U.I., Verona, Italy

    Riccardo Bertolo

  23. Department of Urology, University of L’Aquila, L’Aquila, Italy

    Savio D. Pandolfo

  24. Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy

    Savio D. Pandolfo

  25. Vincenzo Pansadoro Foundation, Rome, Italy

    Vito Pansadoro

  26. Department of Urology, Brigham and Women’s Hospital, Boston, MA, USA

    Filipe L. F. Carvalho

  27. Department of Urology, University of Rochester Medical Center, Rochester, NY, USA

    Jean V. Joseph

  28. Department of Urology, SSM Health St. Anthony Hospital, Oklahoma City, OK, USA

    Mohammad Ramadan

  29. Department of Urology, Mon Health Medical Center, Morgantown, WV, USA

    Jaschar Shakuri-Rad

  30. Department of Urology, City of Hope, Duarte, CA, USA

    Bertram Yuh

  31. Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA

    Jeffrey Nix

  32. Department of Urology, University of California Irvine, Irvine, CA, USA

    David I. Lee

  33. Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Soroush Rais-Bahrami

  34. USC Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA

    Sij Hemal

  35. Department of Urology, University of Florida, Gainesville, FL, USA

    Li-Ming Su

  36. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Maurizio Buscarini, Michael Palese, Ash Tewari, Peter Wiklund, Reza Mehrazin & Ketan Badani

  37. Department of Urology and Urologic Oncology, Saint John’s Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA, USA

    Jennifer A. Linehan

  38. Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China

    Zhenjie Wu

  39. Department of Urology, Hackensack Meridien Health, Hackensack, NJ, USA

    Michael Stifelman & Mutahar Ahmed

  40. Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

    Richard E. Link

  41. Department of Urology, University of Illinois at Chicago Health, Chicago, IL, USA

    Simone Crivellaro

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Contributions

R.A., A. Biasatti and N.A.S. researched data for the article. R.A., A. Biasatti and N.A.S. contributed substantially to discussion of the content. R.A., A. Biasatti, N.A.S. and L.C.Z. wrote the article. R.A., F.P., S.D.P., F.A., R.N., C.R., L.C.Z., A. Ghazi, B.C., C.E., A. Mattei, C.D.F., A. Breda, B.R., F.M., A. Briganti, A.A.P., A. Mottrie, R.D.G., A.H., M.G., M.C.M., V. Patel, G.S., A. Galfano, S.S., R.B., S.P., V. Pansadoro, F.L.F.C., J.V.J., M.R., J.S-R., B.Y., J.N., D.I.L., S.R.B., S.H., M.E., A.T.B., Z.S., L.M.S., M.B., M.P., A.T., P.W., E.E.C., S.V., J.A.L., Z.W., M.S., M.A., R.M., K.B., R.E.L., S.C. and J.K. reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Riccardo Autorino.

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Competing interests

R.N. is a proctor for Intuitive surgical and a consultant for Fortec medical and Lexion. A. Ghazi has a research grant with Intuitive. A. Mattei is the CEO of Orsi Academy and adviser of Medtronic, Conmed, Microport, Medicaroid, Intuitive and Samantree. M.R. is consultant and proctor for Intuitive. J.S.R. is consultant and proctor for Intuitive. S.R.B. received research funding from Blue Earth Diagnostics and Progenics/Lantheus and is consultant for Intuitive Surgical and GE Healthcare. J.A.L. was a speaker for Intuitive surgical and is on the scientific advisory board of Medtronic. M.S. is on the Intuitive advisory board of VTI. M.A. is a consultant for Intuitive surgical, VTI, Ethicon and BioTissue. R.E.L. is a consultant and proctor for Intuitive. S.C. is a consultant and proctor for Intuitive. J.K. is a consultant for Intuitive, Endoquest, VTI and is on the advisory board of Method AI. R.A. is a consultant and proctor for Intuitive and is on the advisory board of Method AI. The other authors declare no competing interests.

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Nature Reviews Urology thanks Abhay Rane and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Biasatti, A., Soputro, N.A., Porpiglia, F. et al. The current landscape of single-port robotic surgery in urology. Nat Rev Urol (2025). https://doi.org/10.1038/s41585-025-01081-z

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