After pioneering the use of single-port robotic surgery in the management of prostate, kidney, and bladder cancers, Mount Sinai has expanded this minimally invasive approach into the realm of rare and complex genitourinary (GU) cancers, benefiting a broader pool of patients, says Reza Mehrazin, MD, Professor and Director of the Urologic Oncology Fellowship Program at the Icahn School of Medicine at Mount Sinai Health. Using the single-port approach, Dr. Mehrazin and his colleagues have been achieving successful outcomes in cases involving retroperitoneal partial nephrectomy, retroperitoneal lymph node dissection, and inguinal groin dissection.
“We always try to be innovators in robotic surgery and explore ways to use the technology to offer more patients less-invasive treatment options, and also educate our residents and fellows on the front line as well,” says Dr. Mehrazin. “Having successfully used this approach for kidney, prostate, and bladder cancers, and gaining invaluable experience and comfort in using it, we decided we should explore its use in other GU pathologies.”
“We always try to be innovators in robotic surgery and explore ways to use the technology to offer more patients less-invasive treatment options, and also educate our residents and fellows on the front line as well,” says Reza Mehrazin, MD.
Dr. Mehrazin says the single-port approach, which typically involves one incision in the lower abdomen, offers several benefits in managing complex GU cancers, most notably the ability to perform these surgeries extraperitoneally. This eliminates operating around other vital intra-abdominal structures while enabling Dr. Mehrazin and his colleagues to access the pathology more efficiently.
“There are situations in which patients are presenting with genitourinary cancer but have undergone multiple abdominal surgeries for a variety of reasons," says Dr. Mehrazin. "Instead of going through the abdomen and dealing with scar tissue or prior surgical changes, as you would using a multi-port or open approach, you can stay in the extraperitoneal space easier and avoid potential unnecessary complications, such as possible bowel complications, and reduce surgical time.”
Mount Sinai began using the single-port surgery around 2020 and adopted it for retroperitoneal lymph node dissection in 2025. Expansion into these pathologies has been facilitated, in large part, through extensive expertise gained in managing patients with prostate, bladder, and kidney cancers. However, there was a considerable learning curve involved as the skills honed through successive multi-port surgeries were not directly transferrable.
For single-port retroperitoneal lymphadenectomy, the main criteria in assessing GU cancer patient suitability for the single-port approach are the extent of the pathology (meaning the size and location of the lymph nodes) and the patient’s body habitus. Dr. Mehrazin prefers to use this approach in a primary setting, given the challenges posed by the surgical planes one can normally see in post-chemotherapy. However, he envisions expanding the approach to post-chemotherapy management as he gains more insights on the efficacy of the procedure.
“The key is to make sure we are maintaining the oncological principles, while trying to add the benefits of minimal invasive surgery,” he says. “Once we have determined that, we can try the approach among other patients who fit the criteria.”
Dr. Mehrazin and his colleagues are collecting data on genitourinary cases managed using the single-port approach. He says all patients have been discharged within 24 hours of surgery and demonstrated faster recovery than with a multi-port approach, with less pain and no complications. Moreover, outcomes have been equivalent to those observed among patients using the multi-port approach. He plans to share these and other findings, along with details about Mount Sinai’s approach at an upcoming conference.