Single-Port Versus Multi-Port Robotic Nephroureterectomy: A Multi-Institutional Contemporary Comparison of Perioperative Outcomes and Tetrafecta Achievement from the ROBUUST & SPARC Collaborative Groups
Recommended Citation
Spena G, Contieri R, Ditonno F, Soputro NA, Ferro M, Decobelli O, Lee R, Ghodoussipour S, Rogers C, Mehrazin R, Djaladat H, Rais-Bahrami S, Kaouk J, Derweesh I, Antonelli A, Gontero P, Mattei A, Minervini A, Simone G, Porpiglia F, Fankhauser C, Crivellaro S, Autorino R, Perdonà S. Single-Port Versus Multi-Port Robotic Nephroureterectomy: A Multi-Institutional Contemporary Comparison of Perioperative Outcomes and Tetrafecta Achievement from the ROBUUST & SPARC Collaborative Groups. Eur Urol 2026; 89.
Document Type
Conference Proceeding
Publication Date
3-1-2026
Publication Title
Eur Urol
Keywords
osteonectin, adult, cohort analysis, complication, conference abstract, controlled study, female, human, lymph node dissection, major clinical study, male, morbidity, neoadjuvant chemotherapy, nephroureterectomy, operation duration, postoperative complication, retrospective study, robot assisted surgery, surgery, transitional cell carcinoma, tumor-free margin
Abstract
Introduction & Objectives: To compare perioperative outcomes and tetrafecta achievement between single-port (SP) and multi-port (MP) robotic nephroureterectomy (RNU) in a contemporary multi-institutional cohort. Materials & Methods: A retrospective review was conducted using data derived from the Robotic Surgery for Upper Tract Urothelial Cancer Study (ROBUUST) and the Single Port Advanced Robotic Consortium (SPARC) Collaborative Registries to identify consecutive RNU cases performed between 2023 and 2025. Perioperative and pathologic outcomes were compared between SP and MP approaches using nonparametric and exact statistical methods. The tetrafecta was defined as the concomitant achievement of bladder cuff excision, lymph-node dissection, negative surgical margins, and absence of postoperative complications within 30 days. Results: Among 466 robotic RNU cases, 341 (73.2%) and 125 (26.8%) were performed using MP and SP approaches, respectively. Baseline characteristics were largely comparable, with slightly more ASA ≥ III and neoadjuvant chemotherapy cases in the SP group. SP procedures had longer operative times (212 vs 203 min) and shorter hospital stays (2 vs 3 days; both p < 0.001), though the absolute differences were small. Complications were also less frequent (21.6% vs 36.7%; p = 0.002). Among tetrafecta components, the absence of postoperative complications was more frequent in SP (78.4% vs 63.3%; p = 0.002), while rates of bladder cuff excision, lymph-node dissection, and negative surgical margins were similar. Overall tetrafecta achievement was comparable between SP and MP approaches (25.5% vs 20.2%; p = 0.250). (Figure Presented)Conclusions: Despite being in an early adoption phase, SP-RNU seems to offer largely comparable perioperative and pathologic outcomes to MP-RNU, with potentially better perioperative morbidity. The limited use of lymph-node dissection is the main driver of overall low tetrafecta rate across both cohorts. Validation in larger, standardized studies is warranted.
Volume
89
