The Regionalization of Urologic Robotic Surgery: How the Single-Port Platform Is Driving a Paradigm Shift Toward Compartment-Based Access

Background/Objectives: The evolution of minimally invasive urologic surgery has progressively reduced incisional burden, yet successive platforms have largely preserved a cavity-based operative paradigm in which the peritoneal cavity serves as the dominant surgical workspace. The da Vinci SP robotic system (Intuitive Surgical, Sunnyvale, CA), through its single-cannula architecture and independently articulating instruments, enables surgery within confined anatomic spaces. We propose “regionalization” as a conceptual framework describing a shift from cavity-based toward compartment-based surgery, in which target organs are approached directly within their native anatomic regions. Methods: This narrative review examines contemporary single-port urologic surgery literature, including systematic reviews and meta-analyses, multi-institutional consortium data, propensity-matched comparative studies, and institutional series. The available evidence is considered in the context of a proposed compartment-based framework for SP urologic surgery. Results: Across the pelvic compartment, superior retroperitoneal compartment, and retroperitoneal reconstructive compartment, the SP platform expands the feasibility of direct transvesical, extraperitoneal, and retroperitoneal access while reducing reliance on the peritoneal cavity as the operative workspace. These approaches allow preservation of surrounding anatomic spaces, direct access to retroperitoneal organs, and greater flexibility in addressing anatomically distributed pathology from a single access site. Available comparative data generally demonstrate comparable oncologic and functional outcomes to multiport surgery, with potential perioperative advantages including shorter hospitalization and reduced analgesic requirements. Current evidence remains predominantly observational and concentrated at experienced high-volume centers. Conclusions: The SP platform enables urologic procedures traditionally organized around cavity-based access to be reorganized around the anatomic compartment of the target organ. This regionalization framework may offer meaningful perioperative advantages while preserving established surgical outcomes, but prospective multicenter studies, longer-term follow-up, and broader institutional experience are needed to define its clinical impact.