AUA 2022: Single Port Robotic Urologic Surgery: Fewer Ports, Higher Costs

( The 2022 AUA Annual meeting held in New Orleans held a session covering contemporary surgical technologies in the field of Urology featuring work from Dr. Brijesh G. Patel and colleagues investigating the cost comparison of surgery between the Da Vinci Xi and SP systems. Featuring magnified stereoscopic vision, movement refinement controls, tremor elimination, and 177 increased degrees of freedom with robotic wrist instruments, multi-port robotic systems enhance surgeon capabilities for better patient outcomes. With the advent of the newly marketed Da Vinci single-port robot, urologic surgery can now be performed through a “key-hole” in which all robotic instruments can mobilize and operate simultaneously. Given its limited use, little has been published on the perioperative outcomes associated with SP surgery in the Urologic field including costs. As such, this abstract compares the overall costs of operating with the Da Vinci Xi to its single port counterpart for robot-assisted partial nephrectomies (RAPN) and robot-assisted laparoscopic prostatectomy (RALP).


This study was conducted as a retrospective cohort analysis of patients who underwent RAPN and RALP between January 2019 and January 2021. With IRB approval, operative costs were calculated based on billing for equipment and operative time provided by the institution’s billing office. A Kruskal-Wallis analysis was performed to assess the correlation between cost and time between Xi and SP systems.

There were 513 cases reported using the Xi platform including 290 RAPN and 223 RALP in comparison to the SP platform, of which 122 cases were included with 102 RAPN and 20 RALP. The cost of RAPN and RALP were 36.5 % and 39 % more expensive when performed using the SP system in comparison to the Xi system, respectively.




When comparing RAPN procedural time, the Xi robot offered a 38-minute shorter operative time than its single port counterpart (p = 0.023). In contrast, the SP robot performed RALP 18-minutes faster than the Xi (p = 0.006).


The cost of minimally invasive robotic surgery is heavily influenced by the costs of robotic instruments and drapings. The SP system on average demonstrated more costly instruments and robotic-specific drapings than the Xi, adding an additional $1,170 - $1, 1820 to overall operative costs. Exact equipment costs were not provided due to institutional policies.



Dr. Biebel’s presentation covering the cost comparisons associated with SP vs. Xi surgery in RAPN and RALP concluded with the following statements:

  • The newer SP platform demonstrates similar short and long-term operative outcomes in comparison to the Xi for RAPN and RALP procedures.
  • Despite similar safety and outcome profiles, the SP system results in ~40% more cost in contrast to the Xi.
  • Given overall costs only included OR time and instrument costs, further studies will need to be performed to incorporate other costs associated with each procedure that were not evaluated.


Presented by: Mark Biebel, MD, Washington University in St. Louis, Saint Louis, MO
Co-Authors: Brijesh Patel, Ramakrishna Venkatesh, Robert Figenshau

Written By: Rohit Bhatt, Leadership and Innovation Research Fellow, Department of Urology, University of California Irvine, @RohitBhatt_ on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.