Single-port Surgery

Overview

What is single-port surgery?

Surgeons perform single-port surgery through a single port — or incision — in your belly button (navel) or abdomen. The location of the incision may vary depending on the surgical procedure. Single-port surgery is a form of minimally invasive surgery. You might hear the term single-port SP surgery.

First used clinically in September 2018, single-port robotic surgery is now widely used in many medical centers worldwide for various procedures. Surgeons in a variety of specialties conduct single-port surgery, including urology, and ear, nose and throat. This innovation continues to provide excellent results, with more rapid recovery and increased patient satisfaction.

What’s the difference between surgical approaches?

There are different approaches to surgery. Your surgeon selects the one that’s best for you based on their experience, your reason for needing surgery and your overall health.

Open surgery

In open surgery, your surgeon creates a large incision. This approach involves more cutting of your tissues.

Minimally invasive surgery

In a minimally invasive surgery (MIS), your surgeon makes a smaller incision. This approach is associated with faster recovery and less pain. Laparoscopic surgery and robotic surgery are both minimally invasive approaches.

In traditional laparoscopic or robotic surgery, the surgeon makes three to five small incisions. The surgical team uses these ports as they insert instruments to perform the surgery. For example, they might use laparoscopic surgery to remove your kidney if needed.

In single-port robotic surgery, the surgeon makes only ONE small cut. They then connect a single-port robot to the port and perform the entire procedure through this opening.

What procedures are possible using the single-port approach?

Surgeons have used the single-port approach for many different types of procedures involving different organ systems, including:

  • Kidney surgeries. These include kidney removal (nephrectomy), donor nephrectomy, kidney transplantation and surgery to repair a blockage between your kidney and your ureter (pyeloplasty).
  • Prostate surgeries, including prostatectomy.
  • Cystectomy, which removes your bladder.
  • Urinary tract reconstruction.

Who can have single-port surgery?

People who are eligible for robotic surgery are generally good candidates for single port surgery with few exceptions. In addition, people who might not be eligible for the regular robotic surgery using the standard robot (those who’ve had multiple major abdominal surgeries, severe pulmonary or cardiac diseases, or morbid obesity) can be candidates for a single-port procedure. Your surgeon will consider your overall health and the severity of your condition when determining the best approach.

How do you prepare for single-port robotic surgery?

In general, you’ll follow the guidelines in place for laparoscopic or robotic surgery. Please follow these policies:

  • Do not eat, drink (including water), or smoke after midnight the day before your surgery.
  • Wear low-heeled shoes the day of surgery. You might be drowsy from the anesthesia and unsteady on your feet.
  • Do not wear jewelry. (You may wear your wedding ring.)
  • Wear loose-fitting clothing. You will have some abdominal tenderness and cramping after surgery.
  • Remove any nail polish before surgery.

How is single-port robotic surgery performed?

  • You’ll receive a general anesthetic to relax your muscles and prevent pain during surgery.
  • The surgeon makes a small incision in the belly or near the navel. They inflate your abdomen to make the organs easier to view. Next, your surgeon inserts the robot with the camera and all necessary instruments through this small incision and performs the surgery.
  • The length of the procedure depends on the type of surgery.
  • After surgery, you’ll usually stay in a recovery room for about one hour. After that, you’ll stay awhile in the outpatient surgery unit for continued observation.
  • Depending on the type and extent of the surgery, you might be able to leave the hospital that day.
  • You won’t be able to drive for 24 hours after surgery. Make sure you have someone available to pick you up and stay with you for those first 24 hours.
  • Follow any discharge instructions you are given, including those regarding your activity levels and making a follow-up appointment.

What are the advantages of single-port surgery?

Because it uses only one port, single-port surgery leaves little to no scarring and may reduce complications that commonly occur after traditional open and even traditional laparoscopic abdominal surgery.

The advantages of single-port surgery include:

  • You might be a candidate for single-port surgery even if you’re not eligible for traditional laparoscopic or robotic surgery.
  • Your surgeon can perform multiple procedures at the same time, using the same single incision. For example, your surgeon can remove the prostate and part of the kidney, which would otherwise require two incisions or two surgeries.
  • People report less pain with single-port surgery.
  • You will not need narcotics for pain relief.
  • You may leave the hospital on the same day of your surgery.
  • Your recovery should be faster. You can be back to your regular daily routine shortly after the procedure.
  • Cosmetically, the scars from your surgery will be almost invisible

photo of abdomen after single port surgery showing little scaring
Umbilical incision three weeks after single-port nephrectomy (kidney removal) leaves little to no scarring.

What are the disadvantages of single-port surgery?

The single-port approach is more challenging than traditional laparoscopy or robotic surgery because your surgeon has less freedom of movement with all instruments using the same entry point. Be sure your surgeon performs these procedures regularly and that it’s performed in a hospital that does many of these procedures each year.

Recovery and Outlook

What is the recovery time after single-port surgery?

In the skilled hands of an expert surgeon, you can usually return to normal activity two to four weeks after a single-port surgery. Your doctor will advise you when it is appropriate to do so.

When can I resume my normal activities after single-port surgery?

If you have housework or other strenuous activities following your procedure, ask a friend or family member to help you. Recovery time from a single-port surgery is less than it would be for an open procedure. But it’s important to allow yourself time to recover.

When to Call the Doctor

When should I see my healthcare provider?

There are multiple conditions involving different body parts for which your surgeon may suggest single-port surgery. Before leaving the surgery center, be sure to ask your care team when you should call them and when you should seek emergency care.

Generally speaking, you should call your healthcare provider if you notice any of the following symptoms after surgery:

Frequently Asked Questions

What’s the difference between single-port surgery and single-site surgery?

Frequently, the terms single-port surgery and single-site surgery mean the same thing.

A note from Cleveland Clinic

Healthcare providers are constantly seeking to make surgical procedures less invasive. One newer technique is single-port surgery. Your provider will discuss this type of surgery with you if you’re a candidate and the appropriate procedure in your case. The advantages include less pain and a quicker recovery.

Last reviewed by a Cleveland Clinic medical professional on 08/21/2021.

References

  • Aminsharifi A, Sawczyn G, Wilson CA, Garisto J, Kaouk J. Technical advancements in robotic prostatectomy: single-port extraperitoneal robotic-assisted radical prostatectomy and single-port transperineal robotic-assisted radical prostatectomy. (https://pubmed.ncbi.nlm.nih.gov/32420199/) Transl Androl Urol. 2020;9(2):848-55. Accessed 11/3/2021.
  • Aminsharifi A, Wilson CA, Sawczyn G, Kim S, Lenfant L, Kaouk J. Predictors Associated with a Prolonged Hospital Stay After Single-Port Extraperitoneal Robotic Radical Prostatectomy: A Comparative Analysis of Outpatient Versus Inpatient Care. (https://pubmed.ncbi.nlm.nih.gov/32597208/) J Endourol. 2020;34(10):1049-1054. Accessed 11/3/2021.
  • Kaouk J, Bertolo R, Eltemamy M, Garisto J. Single-Port Robot-Assisted Radical Prostatectomy: First Clinical Experience Using The SP Surgical System. (https://pubmed.ncbi.nlm.nih.gov/30367924/) Urology. 2019;124:309. Accessed 11/3/2021.
  • Lenfant L, Garisto J, Sawczyn G, et al. Robot-assisted Radical Prostatectomy Using Single-port Perineal Approach: Technique and Single-surgeon Matched-paired Comparative Outcomes. (https://pubmed.ncbi.nlm.nih.gov/33357990/) Eur Urol. 2021;79(3):384-392. Accessed 11/3/2021.
  • Valero R, Sawczyn G, Garisto J, Yau R, Kaouk J. Combined robotic radical prostatectomy and left partial nephrectomy by a single port approach. (https://pubmed.ncbi.nlm.nih.gov/32648436/) Int Braz J Urol. 2020;46(5):869. Accessed 11/3/2021.
  • Valero R, Sawczyn G, Garisto J, Yau R, Kaouk J. Multiquadrant Combined Robotic Radical Prostatectomy And Left Partial Nephrectomy: A Combined procedure by A Single Approach. (https://pubmed.ncbi.nlm.nih.gov/31864774/) Actas Urol Esp. 2020;44(2):119-124. Accessed 11/3/2021.

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