Single‐Port Robot‐Assisted Radical Cystectomy Using Combined Umbilical and Perineal Access: Initial Clinical Experience With Exploratory Comparison of Multiport Surgery

BACKGROUND: Single-port robotic platforms may reduce abdominal access in robot-assisted radical cystectomy (RARC), but the optimal access configuration remains undefined. METHODS: We developed a single-port RARC technique combining umbilical robotic access with perineal stapler access through the urethrectomy site for intracorporeal ileal conduit diversion. Seven patients underwent this procedure and were exploratorily compared with 19 contemporaneous patients undergoing multiport Xi-RARC. RESULTS: All single-port procedures were completed without conversion, with negative surgical margins and no intraoperative complications. Estimated blood loss was lower with SP than Xi (134 vs. 225 mL; p = 0.021). Paralytic ileus occurred in 0% versus 58% (p = 0.010). After Holm adjustment, NRS pain scores were lower with SP on postoperative day 6. CONCLUSIONS: Combined umbilical and perineal access was feasible for single-port RARC with intracorporeal ileal conduit diversion. Exploratory findings suggest potential differences in early postoperative recovery and warrant validation in larger studies.