Feasibility and Safety of Pure Single-Port Robotic Surgery Using the "Integrated Functional Assistant Port" (iFAP) Technique: A Retrospective Cohort Study

Minimally invasive urologic surgery continues to evolve with the adoption of the da Vinci SP® single-port system. However, the lack of effective bedside assistance in "pure" single-port surgery often necessitates an additional "plus-one" incision or relies on flexible instruments with limited functionality. We describe the "Integrated Functional Assistant Port" (iFAP) technique, which incorporates a rigid laparoscopic trocar within a single multi-channel access platform, and evaluate its feasibility and safety. This retrospective cohort study included 60 consecutive patients who underwent pure single-port robot-assisted surgery using the iFAP technique between September 2023 and January 2025. Procedures included partial nephrectomy (RAPN), adrenalectomy, and nephroureterectomy. The iFAP technique involved inserting a standard rigid trocar alongside the robotic cannula through a single umbilical or flank incision. All procedures were successfully completed without conversion. Mean docking and console times were 12.6 ± 6.6 min and 102.4 ± 51.9 min, respectively. The iFAP technique provided stable pneumoperitoneum and effective smoke evacuation. Perioperative complications occurred in 3.3% of patients (one incisional hernia, one ileus), both in the RAPN group. In RAPN subgroup analysis, moderate complexity tumors (RENAL score 7–9) showed longer warm ischemic times than low complexity tumors (26.2 vs. 23.4 min; p = 0.007) but equivalent complication rates. The iFAP technique is a safe and feasible modification that overcomes the functional limitations of pure single-port surgery. By enabling robust rigid assistance within a single incision, it preserves the cosmetic benefits of single-site surgery while maintaining high surgical performance.