Is less more? A meta-analysis comparing single-port and multi-port robotic surgery in children

Background: Single-port (SP) robotic surgery is a recent advancement in minimally invasive techniques, aiming to reduce surgical trauma compared to multi-port (MP) approaches. Nevertheless, its application in pediatric surgery is not yet well defined. This meta-analysis aims to assess the safety and perioperative outcomes of single-port versus multi-port robotic surgery in the pediatric population. Methods: A systematic review and meta-analysis were performed according to PRISMA guidelines. PubMed, Scopus, Web of Science, Medline, and Cochrane Library were searched up to June 2024 for studies comparing SP and MP robotic surgery in pediatric patients (0–18 years). Primary outcomes included operative time (OT), console time (CT), blood loss (BL), length of hospital stay (LOS), conversion rates, and complications. Results: Five retrospective studies, including 147 pediatric patients (87 MP, 60 SP), were analyzed. No significant differences were found in operative time (WMD = 4.56, 95 % CI [-23.10, 32.22], P = 0.71), console time (WMD = 3.05, 95 % CI [-41.87, 47.96], P = 0.88), or complication rates (OR = 1.32, 95 % CI [0.27, 6.59], P = 0.73). Single-port surgery was linked to lower blood loss (WMD = 26.40, 95 % CI [-102.70, 155.50], P = 0.0005) and a slightly shorter length of hospital stay (WMD = 0.30, 95 % CI [-0.04, 0.55], P = 0.02). Neither group experienced any conversions to open surgery. Conclusions: SP robotic surgery appears to be a feasible and safe alternative to MP approaches in children, with potential benefits in reducing blood loss, mainly demonstrated in pyeloplasty, and hospital stay. However, given the heterogeneity and retrospective nature of the current evidence, larger prospective studies are warranted to confirm these findings.