How Single-Port Robotics is Changing Urologic Cancer Surgery – A Conversation with Timothy Clinton, MD

With robotic surgery advancing at an unprecedented pace, Timothy Clinton, MD, explains how single-port robotic technology is making complex procedures simpler and more effective. Learn how Brigham and Women’s Hospital’s expertise is attracting international surgeons for observation and why these innovations are changing the landscape or urologic cancer care.

Q: Robotic surgery has been used in urology, gynecology, and other fields for over a decade. What advancements are happening now?

A: Robotic surgery is growing rapidly, especially across the Mass General Brigham system. A major advancement is the single-port da Vinci robot, which allows for surgery through a single three-centimeter incision instead of multiple incisions. All robotic arms enter the body through that one small entry point, making minimally invasive surgery even less invasive. 

Brigham and Women’s Faulkner Hospital has been early adopters of this technology. Originally designed for ear, nose, and throat surgery, it has now gained FDA approval for urologic procedures, including prostate and kidney cancer surgeries. We’ve even expanded its use to bladder cancer.

Q: What types of urologic cancer do you treat with this new robot?

A: We primarily use it for prostate, kidney, and bladder cancer, but I also focus on applying robotic surgery to testicular cancer. Brigham and Women’s Hospital is leading the way in minimally invasive testicular cancer surgery—not just in New England, but possibly in the entire country.

One of my key areas of expertise is performing robotic retroperitoneal lymph node dissection (RPLND), an emerging but complex lymph node removal procedure used for testicular cancer in cases where the cancer has spread to the lymph nodes underneath the kidneys —located near the aorta and inferior vena cava, a major vein and artery in the lower body. Traditionally, this is done through a large open incision, keeping patients in the hospital for four to five days. With robotic surgery, we’ve cut that down to just one night.

Q: What are the benefits of using the single-port robot for kidney cancer surgeries?

A: The single-port robot has revolutionized our ability to perform kidney surgeries with minimal invasiveness. By working outside the peritoneal cavity, we perform extra-peritoneal/retroperitoneal surgeries, staying in the space around the kidney, which reduces recovery time, bleeding, and post-operative pain. With this approach, patients can often leave the hospital the very next day, compared to the typical two-day stay for traditional kidney surgeries.

Q: Do urologic cancer patients come to Brigham specifically for this robotic technology?

A: Some patients are aware of our advanced technology and specifically seek out the single-port robot, but most come to Brigham and Women’s for our renowned urologic robotic program. We have the largest urologic robotic program in New England, and many of our patients are eager to benefit from the latest innovations in robotic surgery to speed up their recovery. Though not everyone knows about the single-port robot, those who do, find it an appealing option for a quicker, less painful recovery.

Q: Can robotic surgery be used for metastatic cancer, and if so, how does it improve treatment?

A: While robotic surgery is typically not used in cases of widespread metastatic cancer, it is invaluable in treating cancers like testicular cancer, which often spreads to the lymph nodes. In these cases, the robot allows for highly precise, minimally invasive surgeries to remove affected lymph nodes, significantly reducing recovery time and complications. This is especially beneficial for young men, who would otherwise face large, painful incisions with traditional surgery.

Q: How does this robotic technique impact hospital stay times?

A: The difference is significant.

• Prostate removal (radical prostatectomy): At the Brigham, patients go home the same day, spending about four hours in recovery. Nationwide, this is still uncommon.
• Kidney cancer surgery: Patients stay less than 24 hours and go home the next morning. Elsewhere, the typical stay is two days.
• Bladder cancer surgery: We’ve pioneered a technique called intracorporeal urinary diversion, where we reconstruct the bladder (neobladder) inside the body using robotic surgery and the patient’s bowel. This eliminates the need for a large incision, reducing hospital stays by at least two days.
• Testicular cancer surgery: robotic RPLND decreases the length of stay from four nights open to one night with robotic approach.

Q: Does robotic surgery help preserve fertility in testicular cancer patients?

A: There’s no clear data showing it improves fertility, but I believe it helps preserve key nerve structures.

During RPLND, there are nerves around the aorta that affect ejaculation but not necessarily sperm production. The robot provides 10x magnification, making it easier to identify and protect these nerves compared to open surgery. This can be crucial for young men who may want to conceive naturally in the future.

Q: Could this technology only be used in urologic surgeries, or could it be applied to other types of cancer surgeries?

A: Yes! The single-port robot has now received FDA approval for thoracic and colorectal surgeries, as well. While we haven’t started using it for those procedures at the Brigham yet, it’s only a matter of time.

We were one of the first hospitals in the country to adopt this robot, and currently, we perform the highest volume of single-port robotic surgeries in New England, performing over 1,000 urologic robotic surgeries annually. Personally, I perform about 250 annually.  There are only about 60 of these robots in the U.S., and only a few in this region.

Q: Do surgeons from around the world come to the Brigham to learn these advanced techniques?

A: Absolutely. Right now, I have a fellow from São Paulo, Brazil, who is here for six months just to observe our single-port robotic surgeries for testicular and bladder cancer. We’ve also hosted experts from Taiwan, Poland, England and Spain.

Because the Brigham is one of the few centers mastering this technique, international surgeons come to learn from us.

Q: What’s next for robotic surgery?

A: Two big advancements are coming:

1. Single-port robotics will continue to expand nationwide, and we’re already helping hospitals in the region set up their programs.
2. Telesurgery—performing surgery remotely via robotic technology—is already happening in Europe and Asia. While it’s unlikely to be approved in the U.S. soon, the technology is advancing rapidly.

At the Brigham, we live-stream robotic surgeries so surgeons around the world can learn from us in real-time. The idea that a surgeon in Boston could operate on a patient in another country isn’t science fiction anymore—it’s already happening internationally.

Da Vinci Single Port Surgical System. Photos by: ©[2025] Intuitive Surgical Operations, Inc.