The introduction of the purpose-built single-port (SP) robotic platform has allowed for the advent of regionalized minimally invasive surgical approaches for robotic radical prostatectomy (RARP), including the extraperitoneal and transvesical techniques. This study sought to develop a best practice consensus on the key principles, patient selection, surgical techniques, expected clinical outcomes, and learning curves pertaining to SP-RARP.
A modified Delphi consensus was developed by a panel of experts, consisting of a 33-item questionnaire, with each statement rated using a binary Likert scale ('agree' or 'disagree'). The survey was distributed via email to all practicing SP-RARP surgeons across the USA and Europe. Consensus was defined as ≥75% agreement on a given statement.
A total of 53 surgeons participated in the Delphi Consensus across the two rounds. Of 33 statements, 28 (84.8%) reached agreement in the first round. The remaining consensus was achieved in the second round, involving 35 surgeons, and with one additional statement. The panel agreed that, although are no absolute contraindications to SP-RARP, the preference towards specific SP-RARP techniques should remain guided by the individual patients and surgical expertise. Although the SP extraperitoneal technique is recommended to pursue pelvic lymph node dissections, the panel agreed that transvesical SP-RARP showed promise in promoting shorter hospital stay, faster recovery of urinary continence, and utility in patients with extensive prior abdominal surgery. Consensus was also reached on the need for a structured training pathway, with most recommending beginning with extraperitoneal SP-RARP before advancing to the transvesical approach.
This Delphi consensus demonstrates broad agreement among experienced SP surgeons in the USA and Europe, forming the foundation for future research on the clinical utility and necessary training pathways for SP-RARP. Nevertheless, empirical validation based on clinical data from large cohort studies remains important.
BJU international. 2026 Jun 15 [Epub ahead of print]
Nicolas A Soputro, Soroush Rais-Bahrami, Marc Bjurlin, Abhishek Srivastava, Eric Umbreit, Mohamed Eltemamy, Raymond Pak, David G Gelikman, Nicholas Hopson, Albert Geskin, Reza Mehrazin, Maia Vandyke, Michael Palese, Carvell Nguyen, David Ornstein, Mubashir Shabil Billah, Christopher Russell, Bertram Yuh, Alan Thong, Ruben Olivares, Sugandh Shetty, Jaschar Shakuri-Rad, Angelo Baccala, Thomas Osinski, Giuseppe Simone, Sebastien Crouzet, David I Lee, Mark Baker, Mohammad Ramadan, Agostino Mattei, Angelo Porreca, Mohammad Jafri, Antonio Galfano, Richard E Link, Po Lam, Marklyn Jones, Jeffrey C Bassett, Gennaro Musi, Zeyad R Schwen, Alp Tuna Beksac, Christopher Eden, Scott Miller, Paolo Gontero, Daniele Amparore, Francesco Porpiglia, Srinivas Vourganti, Mutahar Ahmed, Francesco Montorsi, Sisto Perdona, Alessandro Izzo, Michael D Stifelman, Simone Crivellaro, Alberto Briganti, Jihad Kaouk, Riccardo Autorino
Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA., Wake Forest Atrium Health Baptist, Winston-Salem, NC, USA., University of North Carolina Chapel Hill, Chapel Hill, NC, USA., Atlantic Urology Clinics, Myrtle Beach, SC, USA., UT Health San Antonio, San Antonio, TX, USA., Mayo Clinic, Jacksonville, FL, USA., Monument Health, Rapid City, SD, USA., Suburban Urology, Pittsburgh, PA, USA., Mount Sinai Hospital, New York, NY, USA., UT Southwestern Medical Center, Dallas, TX, USA., Metro Health, Cleveland, OH, USA., Precision Healthcare Specialist, Naples, FL, USA., Hackensack University Medical Center, Hackensack, NJ, USA., Advent Health, Orlando, FL, USA., City of Hope, Duarte, CA, USA., Stanford Medicine, Stanford, CA, USA., Corewell Health William Beaumont, Royal Oak, MI, USA., Mon Health, Morgantown, WV, USA., Thomas Jefferson University, Philadelphia, PA, USA., University of Rochester Medical Center, Rochester, NY, USA., Regina Elena National Cancer Institute, Rome, Italy., Hospices Civils de Lyon, Lyon, France., University of California Irvine, Irvine, CA, USA., Florida Urology Partners, Tampa, FL, USA., SSM Health, Oklahoma, OK, USA., Lucerne Cantonal Hospital, Lucerne, Switzerland., Policlinico Abano Terme, Abano Terme, Italy., Comprehensive Urology, Detroit, MI, USA., Niguarda Hospital, Milan, Italy., Baylor College of Medicine, Houston, TX, USA., Associated Medical Professionals, Syracuse, NY, USA., UC Health, Highland Ranch, CO, USA., Hoag Medical Group, Newport Beach, CA, USA., European Institute of Oncology, IRCCS, Milan, Italy., Royal Surrey County Hospital, Surrey, UK., Wellstar Health, Atlanta, GA, USA., University of Turin, Turin, Italy., RUSH University Medical Center, Chicago, IL, USA., San Raffaele Hospital, Milan, Italy., Intituto Nazionale Tumori Fondazione Pascale, Naples, Italy., University of Illinois Chicago (UIC), Chicago, IL, USA.