Multi incision vs one incision da Vinci RP - benefits & risks

I don't have any personal experience with single port. I was 70 a year ago when I had multiport NS RARP at a center of excellence (Mayo Phoenix). I would suggest going to an NCI recognized CCOE (there's a list on NCI's website) if that's an option for you. I was 5'11" 186 lbs at the time of surgery. My recovery went very well. I was released the same day as the surgery, my pain level was low and I only needed OTC pain meds, and I was continent immediately after the catheter came out although I did have some minor urine releases as I figured out the new normal. Without my old BPH prostate I pee like I'm 30 years younger. I did have significant ED right after surgery, with it slowly getting better and being mild ED at 1 year, which means I can again engage in intercourse (although not quite as good as before). Before surgery I exercised, lost 9 lbs, and started Kegels about a month before surgery and continue them (although less frequently) to this day. I'm not a medical professional but I do believe the prep work helped, and I really believe getting an excellent surgeon with a lot of experience is really important regardless of which machine they use. Best wishes.

I have had two Da Vinci multi-port surgeries and, in fact, the same incisions were used from my kidney removal as were used for prostatectomy.

I wasn't given a choice in either case and from my anecdotal research after reading your query it would seem that single incision Da Vinci surgery is fairly uncommon and I think this is because it's easier for the doctor to get in and work with multiple sites. Consider that a couple are used for cameras, a couple for tools and clamps and another for removal - and with them being far apart they likely have more room to make that work.

But, after reading, the patient happiness seems to be slightly better with single port vs multiport. I can understand this, particularly initially, because you have six big red ugly cuts in your abdomen that are very unsightly and can all have their own recovery process and "itch recovery". In my case, my RARP left me with an open incision that I had to spend two months packing before it closed.

So I see the argument, for sure.

What I can tell you, after two of these, is that the smaller incisions nearly disappear after about a year or two. My old kidney scars were hardly visible by the time I had RARP 10 years later. You could see them, but they blended in. I have a friend who had the "old" single incision non robotic kidney removal and the scar was significantly larger and much more obvious, even twenty years later.

My own opinion, and this lines up with what my urologist told me for my first surgery, is that the smaller multiport incisions heal faster and are less noticeable over time. But, after reading up a bit more now, I can understand that those first 90 days might be a bit better with a single port.

In the end, I think you should talk a lot more to your urologist to find out. The evidence I've read, all in medical journals, indicate the difference between the two is relatively small and the number of surgeons offering single port are fairly low. You are better off finding the best qualified surgeon and just going with what they recommend, be it single or multi port. It sounds like recovery is the number one factor and the studies are for the first 90 days, so it's not likely to be a long term concern of yours.

I'm 5 months out from RARP, and all my incisions are still red and ugly, but I know from past experience that they will fade nicely (except the one that opened up, that'll be uglier). Since I don't do shirtless modeling I don't really care, so long as my cancer is gone 😅.

I focused on where I preferred to be treated (Johns Hopkins) and which surgeon was going to operate (Dr Han) and not the specifics of the robotic equipment.

I had multiport Da Vinci in Aug 2022 and never even noticed my incisions after.

My surgery and recovery went very smoothly.

Best wishes.

I had multiport surgery and I still have one place that's taking forever to heal up completely. I had a cath for 7 days and UTI antibiotics for 3 days after my cath came out. No infections post cath. They did nerve sparing on one side and standard disection on the other. I'm getting my erections back slowly just like the surgeon said.

I had multiport RARP (five incisions) at the Cleveland Clinic on 6/18/25. Since CC is well-known for single port (mainly Dr. Jihad Kaouk), I asked about that at my initial appointment for two of the same reasons that you mentioned - quicker recovery and early return to continence. My surgeon (Dr. Christopher Weight) said that he hadn't seen strong enough evidence to justify switching from multiport to single port yet and that he considered single port mostly "marketing."

Sample size of one here, but I was up and walking the day of surgery, only took Tylenol for two days (no narcotics), and have had almost zero continence issues - just a minor dribble here and there. My incisions are healing fine and only itch when I walk outside in the heat vs. on the treadmill. Dr. Weight was able to do bilateral nerve sparing, but I'm not sexually active and haven't attempted to get an erection so I don't have any info to offer on that front. From what I've gathered, there are certain cases where single port may be advantageous, but in general you'll likely get similar outcomes from an experienced multiport surgeon. I agree with @survivor5280 - find an experienced surgeon that you're comfortable with and go with whichever approach they recommend.

Hi Jay, when did you have surgery and where? Thx Tim

Hi, when you say 6-18, do you mean June 18, 2025? Thx!

Yes, two weeks ago today.

On our consult with surgeon we were told that both options are available and done by this surgeon but we decided to go with multi-port since it is older technique and thus means that while surgeon did thousands of multi-port surgeries, he might have done just a few hundreds using a new technique.
I decided to follow advise of my old friend who is a doctor and stick to "what a surgeon is used of doing". She told me long time ago that if I do not like the technique of any surgeon it is better to look for another one instead of asking for the "particular way".
Also, as far as I was able to find in literature, multi-port gives more maneuverability and can have advantages depending of the location of the cancer.
Of course, this all might be proven to be a wrong approach in about 15 years when everybody may start to use only a single port and new data shows something completely different *sigh

Well…those of us who had radical prostatectomy, chose one or the other method, so a comparison is not possible. But…my urologist told me that he only does the single-incision DaVinci robotic method. I don’t know what is better, especially for post-op recovery, nor if 5 smaller 1/2” holes are better than the one 2.5” to 3” single incision. I just know that I was lulled into thinking the DaVinci robotic single incision would be better...a breeze per my urologist. I was very wrong. My surgery was mid-April, and the first two weeks were pretty bad with pain (needed 10 mg Percocet); the constipation due to the narcotic-based Percocet; and the feeling that I had been assaulted, pummeled, and beat down below my navel. It was very deep pain…scary deep that stops you in your tracks. Your pelvic floor muscles take the brunt of the surgery. That along with losing two of your three urinary sphincters with the resulting urinary incontinence made it miserable. It was bad enough, plus the exasperating incontinence, that I regret having the surgery. My dad lived to with two months of age 100 years. My maternal grandfather lived to 96; and my maternal uncle lived to 86…all with prostate cancer that never saw them have the prostatectomy. They all died of something else. Maybe I would have enjoyed the same longevity.