WATCH: Houston Methodist Urologists Refine Advanced Single-Port Robotic Surgery Technique

Houston Methodist urologists are advancing the frontiers of minimally invasive surgery with a new approach to single-port robotic surgery known as the dock stacking technique. The method, refined by Drs. Monty Aghazadeh, Michael Brooks and Wesley Ekeruo, is enabling more efficient operations, shorter recovery times and expanded treatment options for patients with both benign and malignant urologic conditions.

"Initially, we thought this was just the next generation of robotic surgery," says Dr. Aghazadeh, an assistant professor of Clinical Urology at Houston Methodist West and moderator of a new roundtable video highlighting the technique. "What we didn't realize was how revolutionary it would be. It has completely changed how we approach surgery, and it's truly been practice-changing."

From multi-port to single-port innovation

Traditional multi-port robotic systems require several incisions and significant time navigating the abdominal cavity. By contrast, the single-port robotic surgery platform, FDA-approved in 2019, allows surgeons to operate through a single small incision, approaching organs directly while avoiding unnecessary disruption of surrounding tissue.

"With multi-port systems, access to the retroperitoneum or pelvis could be done, but it was challenging," explains Dr. Brooks, a urologic oncologist with the Dr. Mary and Ron Neal Cancer Center at Houston Methodist West Hospital. "The single-port robot is purpose-built for that kind of direct access. It means smaller incisions, minimal exposure and better efficiency."

The Houston Methodist team's dock stacking technique further enhances this platform. The approach allows surgeons to seamlessly transition between intravesical and extravesical spaces without reverting to open techniques or adding retractors. Originally developed to improve outcomes in transvesical prostatectomies, it is now applied to radical prostatectomies and other procedures.

"We realized we were using this sophisticated robot but still doing parts of the surgery like an open case," says Dr. Aghazadeh. "Dock stacking lets us fully leverage the robot, streamlining the surgery while avoiding unnecessary steps."

Dock stacking benefits

The impact has been significant. Across roughly 500 cases performed since 2023, the surgeons report faster recovery, reduced pain, minimal blood loss and the ability to discharge many patients the same day — even after complex surgeries.

"Patients are up walking, eating regular food and often going home within 24 hours," says Dr. Brooks. "That's a category difference in recovery."

The approach also broadens candidacy for surgery. Elderly patients and those with prior abdominal operations, once considered poor candidates for minimally invasive procedures, can now undergo treatment safely.

"Cases that would have been extremely difficult, even impossible, with multi-port robotics are now straightforward," notes Dr. Ekeruo, a urologist at Houston Methodist West. "It has greatly expanded the range of patients we can help."

The team emphasizes that their success is rooted in a two-surgeon model, likened to a "pilot and co-pilot" system of aviation. This collaboration has accelerated the learning curve, ensured safety and allowed the group to proctor other surgeons adopting the technology nationwide.

"It's one of the unique aspects of our program," says Dr. Aghazadeh. "We work together in the operating room, bringing our individual expertise to every patient. That team-based approach has been key to our impressive outcomes with this new technique."

Click on the image above to view the full roundtable discussion on the use of single-port robotic surgery at Houston Methodist.