Single-Port Surgery

What is single-port surgery?

Single-port surgery is a form of minimally invasive surgery. Surgeons perform surgery through a single cut (incision) in your skin, such as your abdomen. But the location may vary depending on the type of surgical procedure you need. A port is a device that surgeons insert through the incision. Surgeons place instruments in and perform surgery through the port.

Surgeons in many specialties conduct single-port surgery. But urologists commonly perform single-port abdominal surgery. Urologists specialize in diseases and conditions that affect your urinary system and the male and female reproductive systems.

Healthcare providers sometimes use the terms SP surgery or single-port robotic surgery.

What is single-port robotic surgery?

Single-port robotic surgery uses specialized technology (a “surgical robot”) to help surgeons perform procedures through one small incision. The robot allows surgeons to make small, delicate movements and magnify areas with a camera.

Surgeons first used a dedicated single-port robotic surgery platform in a clinical setting in September 2018. It provides excellent results, with faster recovery and increased patient satisfaction.

What is the difference between surgical approaches?

There are different approaches to surgery. Your surgeon will recommend an approach that they believe is best for you, according to their experience, the reason you need surgery and your overall health.

Open surgery

In traditional open surgery, a surgeon creates one large incision. This approach involves cutting more of your tissues. Traditional open surgery usually causes more pain and has a slower recovery.

Minimally invasive surgery

In minimally invasive surgery (MIS), a surgeon makes one or more smaller incisions. In most cases, MIS results in faster recovery and less pain. Laparoscopic surgery and robotic surgery are both minimally invasive approaches.

A surgeon usually makes three to five small incisions in laparoscopic or robotic surgery. But you may need six or more incisions, depending on the type of procedure you need. The surgical team uses these ports to insert instruments to perform surgery. For example, they might use laparoscopic surgery to remove your kidney.

A surgeon makes only one small incision in single-port robotic surgery. 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 use the single-port approach for many different types of procedures involving different organ systems. These may include:

• Kidney surgeries, including kidney removal (nephrectomy), kidney donor nephrectomy, kidney transplant and surgery to repair a blockage between your kidney and ureter (pyeloplasty)
• Prostate surgeries, including prostate removal (prostatectomy)
• Bladder surgeries, including bladder removal (cystectomy)

Who can have single-port robotic surgery?

People who are eligible for robotic surgery are generally good candidates for single-port surgery. You may also be a good candidate for single-port surgery if you aren’t eligible for typical robotic surgery using the standard robot. For example, if you:

• Have had multiple major abdominal surgeries
• Have had severe pulmonary (lung) or cardiac (heart) diseases that cause positioning problems

A surgeon will consider your overall health and the severity of your condition when determining the best approach.

How should I prepare for single-port surgery?

Before single-port surgery, your surgeon will explain how they’ll use the surgery to treat your condition and ask for your consent. They’ll perform a physical exam to ensure you’re healthy enough for surgery. They’ll also ask questions about your:

• Health history
• Any medications you’re taking
• Any allergies you have

In general, you’ll follow these guidelines before single-port surgery:

• Don’t eat or drink (including water) at least eight hours before your surgery. If you must take medications, take them with a small sip of water.
• Wear loose-fitting clothing. You’ll feel some abdominal tenderness and cramping after surgery.
• Wear comfortable, low-heeled shoes. You might be drowsy or unsteady on your feet after surgery.
• Don’t wear jewelry. Jewelry isn’t sterile and may transmit bacteria to your incision, causing an infection.
• Don’t wear nail polish or acrylic (fake) nails. Bacteria can remain in nail polish, even after washing your hands, and cause an infection. Healthcare providers will also monitor your blood oxygen level with a pulse oximeter on your finger. Nail polish may interfere with a pulse oximeter.

What happens during single-port surgery?

In general, your care team will perform the following during single-port surgery:

• Your anesthesiologist will give you general anesthesia. You’ll be asleep, your muscles will relax and you won’t feel any pain during surgery.
• Your surgeon will make a small incision in your belly or near your belly button. The incision location can change according to the type of surgery.
• Your team will inflate your belly with carbon dioxide gas, which creates space to perform surgery.
• Your surgeon will insert the robot and all necessary instruments through the small incision and perform the surgery.

How long does single-port surgery take?

It depends on the exact type of procedure. Even then, the operating time can vary from person to person. But on average, single-port surgery takes two to four hours to complete.

What happens after single-port surgery?

After surgery, healthcare providers will track your overall health, treat your pain and give you recovery instructions. Be sure to follow these instructions, including those regarding physical activity and follow-up appointments.

Once they determine you’re healthy enough, they’ll let you go home. You won’t be able to drive for at least 24 hours after surgery. You must have someone available to take you home and stay with you for at least a day or two.

What are the benefits of single-port robotic surgery?

One of the main benefits of single-port surgery is that, because it uses only one small incision, you’ll have little to no scarring. You may also have a lower risk of complications that commonly occur after traditional open and even traditional laparoscopic abdominal surgery.

Other single-port surgery advantages include:

• You may 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, they can remove your prostate and part of your kidney, which would otherwise require two incisions or two separate surgeries.
• People report less pain with single-port surgery.
• You may be able to leave the hospital on the same day as your surgery.
• Your recovery should be faster. Many people can return to their regular daily routines shortly after the procedure.

What are the disadvantages?

Single-port surgery is more challenging than traditional laparoscopy or robotic surgery because surgeons have less freedom of movement with all instruments using the same entry point. It’s important to make sure your surgeon performs single-port surgery regularly in a hospital that does many of these procedures every year.

All types of surgeries have risks. Other general surgical risks include:

• Anesthesia risks
• Infection
• Organ damage
• Healing problems
• Fluid buildup at the surgical site (seroma)
• Bleeding

Ask your care team about any additional complications for your specific surgery.

What is the recovery time after single-port surgery?

In the skilled hands of an experienced surgeon, you can usually return to your typical activities two to four weeks after single-port surgery. Your surgeon will give you a better estimate of your recovery time.

It’s a good idea to ask a family member or friend to help out with housework, yardwork or other strenuous activities after single-port surgery. Recovery time is less than it would be for an open procedure. But it’s important to allow yourself time to recover.

When can I go back to work or school?

It depends on what you do for work. Most people can return to school or work about a week after single-port surgery. But if you have a more physically demanding job, it’s a good idea to take more time off. You may need to take up to four weeks off to recover.

When should I call a healthcare provider?

Be sure to ask your care team when you should call them and when you should seek emergency care after a single-port surgery.

In general, you should call a healthcare provider if you notice any of the following symptoms after surgery:

• Changes in how you pee, including peeing more than usual (frequent urination) or changes in the color of your pee
• Swelling (edema) in your legs, lower back or face
• Increasingly high blood pressure
• Nausea or vomiting
• Brain fog

Is robotic surgery better than open surgery?

It depends. Robotic surgery can be less painful, reduce your healing time and give your surgeons more control. Your surgeon will always offer you the least invasive treatment option possible. But in some cases, traditional open surgery may be a better option if you:

• Have a lot of muscle or tissue damage
• Have a lot of scar tissue from previous surgeries
• Need treatment on a large or complex organ that’s more difficult to access

What is the difference between single-port surgery and single-site surgery?

Single-site surgery is another name for single-port surgery.