Single-Port versus Multi-Port Robot-Assisted Partial Nephrectomy: a Multivariate Analysis of the Surgical Trifecta

Introduction Evidence from the literature suggests that patients with more complex tumors are less likely to achieve the surgical trifecta—defined as negative margins, ischemia time under 25 minutes, and the absence of Clavien-Dindo grade III or higher postoperative complications. The purpose of this study is to compare trifecta achievement between single-port (SP) and multi-port (MP) robotic cohorts at a high-volume institution and to assess the impact of nephrometry score and demographic factors on these outcomes. Methods Our institution’s IRB-approved, prospective renal cancer database was used to identify 753 patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN) from 2017 to 2025. Patients were stratified into cohorts based on SP and MP RAPN approach. Trifecta rates for each group were estimated using Wilson score 95% confidence intervals. Multiple logistic regression models assessed associations between trifecta achievement and surgical approach, age, sex, body mass index (BMI), nephrometry score, and tumor size. Results The SP RAPN (N = 102) cohort included fewer male patients and had lower BMI, nephrometry scores, and tumor sizes compared to the MP cohort (N = 494). Trifecta achievement did not differ significantly between the SP (76%) and MP (80%) groups ( p  = 0.46). The odds of trifecta achievement were not significantly influenced by surgical platform choice (p = 0.052). Among the factors we analyzed, only nephrometry score was significantly associated with trifecta achievement, while surgical approach showed no significant association. Conclusion We conclude that experienced surgeons using the single-port platform can achieve similar trifecta outcomes during robot-assisted partial nephrectomy compared to multi-port, regardless of tumor complexity.