State of the Art: Single-Port Robot-Assisted Extraperitoneal Transvesical Surgery—Technique, Indications, Outcomes, and Pitfalls

BACKGROUND: The transvesical route provides direct access to the bladder and prostate whereas avoiding peritoneal entry. With the advent of the da Vinci Single-Port (SP) platform, the extraperitoneal (EP) transvesical procedure has reemerged as a minimally invasive option for benign, oncologic, and reconstructive urologic procedures. However, guidance regarding setup, patient selection, outcomes, and technical challenges remains limited. OBJECTIVES: To provide a procedure-oriented overview of the SP robot-assisted EP transvesical procedure, focusing on access, indications, outcomes, and technical considerations for safe adoption. METHODS: Narrative review of contemporary literature and technical reports describing SP EP transvesical access and its applications, including benign prostatic hyperplasia procedure, prostatectomy, reconstruction, perioperative outcomes, complications, and functional results. RESULTS: Access generally involves a short suprapubic incision, cystoscopic transillumination, and stay sutures to secure a limited cystotomy for SP placement, followed by layered closure. In benign disease, SP transvesical simple prostatectomy provides significant symptom improvement, enhanced urinary flow, low blood loss, and potential same-day discharge. For localized prostate cancer, SP transvesical radical prostatectomy demonstrates acceptable early oncologic outcomes with rapid continence recovery and short catheter duration, although large glands and extended lymphadenectomy may limit applicability. Emerging reconstructive indications, including bladder diverticulectomy, vesicovaginal fistula repair, and posterior urethroplasty, appear feasible but remain supported by limited evidence. Technical challenges include avoiding peritoneal entry, maintaining instrument reach, preventing bladder wall injury, and overcoming the learning curve. CONCLUSIONS: The SP transvesical procedure represents a safe and effective access route for diverse urologic procedures, with encouraging perioperative and functional outcomes. Further studies are needed to define its long-term role considering limitations related to cost, availability, and training requirements.