Single Port Extraperitoneal Versus Multiport Transperitoneal Radical Prostatectomy: A Systematic Review and Meta-Analysis

The emergence of extraperitoneal single-port robotic-assisted radical prostatectomy (RA-SPRP) as a minimally invasive surgical approach has prompted comparisons with the well-established multi-port transperitoneal technique (RA-MPRP). This study aims to systematically review and analyze perioperative, oncologic, and functional outcomes between RA-SPRP and RA-MPRP. A systematic review and meta-analysis were conducted following PRISMA guidelines and registered in PROSPERO (CRD420250648505). Databases including PubMed, EMBASE, SCOPUS, and others were searched up to April 2025. Comparative studies reporting relevant outcomes between RA-SPRP and RA-MPRP were included. Primary endpoints were positive surgical margins and biochemical recurrence. Secondary outcomes included operative time, console time, estimated blood loss, hospital stay, complications, continence, erectile function, and catheter removal time. Methodological quality was assessed using the ROBINS-I tool. Seven studies comprising 1997 patients were included. RA-SPRP demonstrated a significantly shorter console time (MD: -83 minutes; 95% CI, -29.61 to -4.05; P < .05) and hospital stay (MD: -1.29 days; 95% CI, -2.55 to -0.02; P < .05). Time to catheter removal was also shorter in the single-port group (MD: -2.80 days; 95% CI, -2.98 to -2.62; P < .05). No significant differences were observed in operative time, estimated blood loss, positive surgical margins, biochemical recurrence, complication rates, continence, or erectile function. Study heterogeneity and methodological limitations-particularly the predominance of retrospective designs-warrant cautious interpretation. RA-SPRP appears to offer perioperative, oncologic, and functional outcomes comparable to RA-MPRP, with potential advantages in early recovery and shorter hospital stay. These findings support the feasibility of RA-SPRP, especially in select clinical contexts, but underscore the need for randomized controlled trials with standardized protocols to validate these observations.