Assessing the minimal invasiveness of pure single-incision da Vinci SP surgery for right-sided colon cancer: comparative analysis with the da Vinci Xi system using PSM and IPTW.

[BACKGROUND] Few studies have compared the invasiveness and safety of pure single-incision robotic surgery using the da Vinci SP system (SP) without an assistant port with those using the da Vinci Xi system (Xi) for right-sided colon cancer. Surgical invasiveness was assessed using the C-reactive protein/albumin (CRP/Alb) ratio and postoperative pain using the Numerical Rating Scale (NRS).

[METHODS] This single-center retrospective study included 163 patients who underwent robot-assisted surgery for right-sided colon cancer between October 2022 and August 2025 (SP = 60, Xi = 103). Confounding factors were adjusted using propensity score matching and stabilized inverse probability of treatment weighting based on body mass index (BMI) ≥ 25 kg/m, American Society of Anesthesiologists (ASA) ≥ III, tumor size ≥ 40 mm, surgical procedure, and preoperative CRP/Alb ratio ≥ 0.03; short-term outcomes were compared.

[RESULTS] After adjustment, baseline characteristics were well balanced. The SP approach was associated with a shorter incision length (3.0 vs 5.5 cm, p < 0.01) and lower postoperative pain on day 3 (NRS scores 2 vs. 3, p < 0.01). Operative time, postoperative inflammatory response assessed by CRP/Alb ratio, complications, and pathological outcomes were comparable between the groups.

[CONCLUSIONS] Pure single-incision robotic surgery using the da Vinci SP system demonstrated comparable short-term safety and oncological adequacy to the Xi system, with modest advantages in incision length and postoperative pain. No clear benefit in systemic inflammatory response was observed, and further validation in larger, prospective, multicenter studies is warranted.