Comment on: “Upper Urinary Tract Surgery Through Robotic Single-Port System vs Multiport and Laparoendoscopic Single-Site Systems: A Systematic Review and Meta-Analysis” by Shi et al.

With great interest, we read Shi et al.'s ¹ recently published article, “Upper Urinary Tract Surgery Through Robotic Single-Port System vs Multiport and Laparoendoscopic Single-Site Systems: A Systematic Review and Meta-Analysis,” in the Journal of Endourology. This finding will provide clinicians with evidence-based treatment options for robotic single-port system and is highly commendable. We are grateful to the authors for their remarkable work. Nevertheless, we would like to make some comments on this topic.

Although the meta-analysis provides robust evidence for its application in clinical practice, there are still certain details that need to be considered. The hospital stay of the two groups of patients is summarized in Table 1, as reported by Shi et al.; however, no further meta-analysis was conducted. Recently, a meta-analysis of seven studies revealed that, compared with multiport (MP) robot-assisted radical prostatectomy, single-port robot-assisted radical prostatectomy had a shorter hospitalization period. ² However, the potential of robotic single-port system to reduce the length of stay for upper urinary tract surgery in comparison with MP and laparoendoscopic single-site (LESS) systems remains inconclusive. Adding the outcomes to the study may help many readers gain a better understanding of the conclusions drawn from this article.

There was another potential concern of the systematic review. The comparison group underwent MP or LESS surgery with the da Vinci^® Xi or Si system, but no subgroup analysis was conducted to explore the potential implications of this difference. Recently, Lei et al. ³ conducted a comparative analysis of the surgical outcomes between the Xi and Si systems for robot-assisted radical prostatectomy. The results suggested that the Xi system had superior perioperative outcomes, including shorter operative times, shorter catheterization times, and reduced postoperative bed rest times, in comparison with the Si system. Hence, the analysis of perioperative outcomes may be subject to bias. We are confident that addressing the aforementioned issues will render the authors' findings more comprehensible.

Oncologic outcomes are essential metrics for assessing the quality of surgical interventions. Marszalek et al. ⁴ demonstrated that positive surgical margin (PSM) might not be a reliable indicator of local recurrence, as other factors such as tumor size, surgical approach, and tumor stage could all potentially influence PSM. ⁵ In the included studies, two studies reported the local recurrence rate in the robot-assisted partial nephrectomy. To better aid readers in understanding this article, providing additional details on such factors would be beneficial.