Hypothesis / aims of study
To compare perioperative, oncologic, and functional outcomes between multiport Xi transperitoneal and single-port (SP) transvesical robot-assisted radical prostatectomy (RARP)
Study design, materials and methods
We performed a retrospective single-center analysis of 81 consecutive patients who underwent RARP between March 2024 and December 2025 (Xi, n=50; SP, n=31). Baseline characteristics including age, PSA, prostate volume, PSA density, ISUP grade, and clinical stage were comparable between groups (all p>0.05). Perioperative, pathological, oncologic, and functional outcomes were analyzed. Continence was defined as no pad or safety pad use. Kaplan–Meier analyses were conducted for continence recovery and biochemical recurrence (BCR)-free survival.
Results
Operative time was significantly shorter in the Xi group (156.9±31.8 vs 181.8±135.7 minutes; p=0.003), while estimated blood loss was comparable (p=0.253). The SP group required no postoperative drains, whereas the Xi group had a mean drain duration of 1.84±1.11 days (p<0.001). Foley catheterization and hospital stay were shorter in the Xi group (5.98±0.97 vs 7.45±1.50 days; p<0.001).
Positive surgical margins were lower in the Xi group (13.6% vs 32.1%; p=0.059). During follow-up (7.1±6.4 vs 9.1±5.4 months; p=0.134), BCR occurred in 11.4% of Xi patients and 28.6% of SP patients (p=0.064). Overall continence rates were comparable (84.1% vs 92.9%; p=0.273). However, early continence recovery favored the SP group, with higher rates at immediate, 1-month, and 3-month time points (39.3%, 53.6%, and 89.3% vs 13.3%, 24.4%, and 66.7%, respectively). Kaplan–Meier analysis demonstrated faster time to continence recovery in the SP group (median 1.25 vs 3.35 months). Potency recovery was significantly higher in the SP group (53.6% vs 27.3%; p=0.025).
Interpretation of results
The SP transvesical approach appears to facilitate earlier functional recovery, particularly in urinary continence and sexual function, likely due to preservation of anterior anatomical structures and reduced disruption of periurethral support mechanisms. The absence of drain placement further supports a less invasive intrapelvic profile of the transvesical technique.
In contrast, the Xi transperitoneal approach demonstrated shorter operative time and trends toward improved oncologic outcomes, including lower positive surgical margin rates and reduced BCR, which may reflect greater procedural familiarity and more standardized oncologic dissection. The lack of statistical significance in oncologic endpoints suggests that these differences should be interpreted cautiously, particularly given the limited sample size and follow-up duration.
These findings indicate a potential trade-off between early functional recovery and oncologic robustness. Surgical approach selection may therefore benefit from individualized decision-making based on patient priorities and tumor characteristics.