What the comparative literature reports
The 2025 Ficarra meta-analysis analysed 9 SP vs MP studies for partial nephrectomy. SP was associated with a shorter hospital stay (SMD 0.31; 95% CI 0.03 to 0.59) and lower day-1 pain scores (SMD 0.22; 95% CI 0.01 to 0.43), but a longer warm ischaemia time (SMD -0.32; 95% CI -0.58 to -0.06).1 Warm ischaemia time reflects how long the blood supply to the kidney is interrupted during tumour excision; shorter is generally better. A 2024 dedicated SP vs MP partial-nephrectomy meta-analysis (Nguyen et al., 2,689 patients across 15 studies) confirmed the small clamp-time difference but found no measurable difference in post-operative kidney function (eGFR) or margins.9
Suitability
Whether SP partial nephrectomy is appropriate depends on tumour size and location, renal function, prior surgery, body habitus, and the need for lymph node work. Some very complex renal masses are better served with multiport triangulation.1,2 The approach is discussed at consultation with review of cross-sectional imaging.
Retroperitoneal access
Because all instruments enter through one cannula, SP is well suited to a retroperitoneal approach for kidney surgery in selected cases, working without traversing the peritoneal cavity.5,14