True Single-Site Partial Nephrectomy Using the SP Surgical System: Feasibility, Comparison with the Xi Single-Site Platform, and Step-By-Step Procedure Guide

Background: Robotic laparoendoscopic single-site (LESS) partial nephrectomy is not widely used because of its limitations, and true single-site surgery has not previously been possible. To investigate the feasibility of partial nephrectomy using the novel SP surgical system, compare perioperative outcomes using this system and the previous Xi single-site platform (XiSSP), and describe how true single-site partial nephrectomy is possible with the SP system. Methods: Retrospective chart review of patients undergoing robotic partial nephrectomy by a single surgeon using the SP surgical system or XiSSP from December 14, 2016 to June 14, 2019. For the SP system, a GelPOINT access platform was placed through a single periumbilical incision. A 25-mm multichannel robotic port and assistant's ports were placed in the GelSeal cap. No additional incisions were required for the assistant or liver traction. The primary outcomes were intraoperative and postoperative complications. Results: Fourteen patients underwent single-site partial nephrectomy with the SP surgical system (n = 9) or XiSSP (n = 5). No limitations were noted for accessing tumors in the upper aspect of the kidney using the SP system. One case of tumor fracture occurred with the SP system, and one case of conversion to multiport robotic surgery occurred with the XiSSP. The postoperative course was uneventful in all patients; only Clavien-Dindo 1 complications occurred. Conclusions: True single-site partial nephrectomy was performed safely with the SP surgical system. The SP system resolved many limitations associated with LESS and the XiSSP.