Safety and efficacy of different surgical approaches in single-port robot-assisted radical prostatectomy based on propensity score matching analysis

PURPOSE: The optimal surgical approach (transperitoneal vs. extraperitoneal) for single-port robot-assisted radical prostatectomy (SP-RARP) remains a subject of ongoing debate, with limited high-quality evidence to compare their safety and efficacy. This study aimed to compare the safety, effectiveness, and functional outcomes of transperitoneal (SP-TPRP) and extraperitoneal (SP-EPRP) approaches in SP-RARP using propensity score matching (PSM). METHODS: This retrospective study analyzed 211 consecutive patients who underwent SP-RARP at a tertiary referral center (2018-2024): 58 SP-TPRP and 153 SP-EPRP. PSM was performed to balance baseline covariates. Perioperative outcomes were compared between the two groups. Time to urinary continence recovery was assessed using Kaplan-Meier analysis. RESULTS: After PSM, 55 patients per group were analyzed. The SP-EPRP group demonstrated significantly higher estimated blood loss (150.0 vs. 100.0 mL, p = 0.021) and a shorter hospital stay (1 vs. 2 days, p < 0.001), and lower pain scores(0.0 vs. 4.0, p < 0.001). Gastrointestinal complications occurred exclusively in SP-TPRP (n = 5), while lymphoceles only in SP-EPRP (n = 4). No significant differences were found in operative time, overall complications, short-term oncological outcomes or function recovery. Kaplan-Meier analysis showed no significant difference in time to continence recovery between approaches (p = 0.32). CONCLUSIONS: Both approaches achieve comparable oncological outcomes, perioperative safety, and functional recovery. SP-EPRP was associated with shorter hospital stay and lower early postoperative pain, but higher estimated blood loss. Both approaches appear clinically feasible, and prospective studies with longer follow-up are warranted to validate these findings.