SDD following RAPN has emerged as a growing practice in select surgical centers driven by advancements in minimally invasive techniques, and enhanced recovery after surgery (ERAS) protocols, all of which have shortened recovery times, hospital stays, and their associated costs [22]. ERAS protocols have been instrumental in supporting the shift toward SDD after RAPN. These, standardized, evidence-based perioperative care pathways aim to reduce surgical stress, promote early recover, and minimize hospital stays. Key components perioperative counselling, avoidance of prolonged fasting, use of regional or multimodal anaesthesia to limit opioid use, early mobilisation, and prompt return to oral intake [23].

This review demonstrates that the implementation of SDD after RAPN can be safely implemented without compromising short-term perioperative outcomes. Patients discharged on the same day have shown comparable rates of complications, readmission, and emergency department visits when compared to those who remain hospitalized overnight (Table 3).

However, the adoption of SDD RAPN remains variable across institutions due to several challenges in implementation. These include logistical considerations such as health care restructuring, and patient access. Clear, evidence-based selection criteria are vital to minimize complications and reduce the risk of failed SDD. Current practices often rely on arbitrary exclusion that don’t account for individual differences. Predictive models may help refine selection and support more personalized decisions [24].

Outpatient RAPN has been slower to gain traction compared to its use in robotic-assisted laparoscopic prostatectomy (RALP) [25]. While SDD is now a more common practice for many RALP procedures, most RAPN patients are still kept overnight for observation [26]. A number of studies have look at overnight stays following RAPN as a more cautious approach, suggesting that full outpatient pathways are still evolving for this type of surgery. Abaza and Shah, 2013, reported that discharge on day 1enha postoperatively is feasible in most patients who had undergone RAPN irrespective of case complexity [27]. The low readmission rates suggest that extended hospital stays may not reduce complications when patients are appropriately selected and meet discharge criteria [27]. Another study by Carbonara et al., found that a single overnight stay after RAPN is feasible and safe [28].

Recent evidence shows that implementing SDD can reduce costs without compromising outcomes. Wood et al. (2023) reported that the introduction of an SDD pathway lowered the mean total cost per patient to $5222 compared with $8425 for inpatient care, reflecting a reduction of over $3000, with no increase in readmissions or emergency department visits [11]. Similarly, Wald, et al. (2024), demonstrated that SDD reduced costs after RAPN by and average of $3091 (18%) and after robotic nephrectomy by $4003 (25%), again without differences in complication rates [20].

The studies in this review support the feasibility of SDD following RAPN, with most reporting no differences in complication or readmission rates. Additionally, when applied to carefully selected patients, SDD can potentially reduce overall healthcare costs.

Patient selection is a critical determinant of success for SDD following RAPN, as not all cases are suitable for outpatient management. Careful preoperative assessment is essential to identify individuals who are most likely to benefit from early discharge without compromising safety or outcomes. Factors influencing eligibility include tumor-related characteristics such as size, location, and complexity, all of which can impact the technical difficulty of the procedure and the potential for intraoperative challenges. Equally important are patient-specific factors including overall health status, presence of comorbidities [26], which is commonly assessed using the Charlson Comorbidity Index (CCI) across the studies. Intraoperative variables, including greater estimated blood loss, longer operative times, and prolonged warm ischemia time, have also been linked to longer hospital stays [21]. These considerations highlight the importance of comprehensive approach to patient selection as well as flexibility to adjust planned same day discharge if unexpected intraoperative complications arise.

Another point to consider is the fact that SDD following RAPN might not be feasible outside high-volume centres with experienced urological surgeons and a dedicated outpatient surgery infrastructure [21]. Bernhard et al. (2022), reports that hospital and surgeon volume can play a role in favoring intraoperative outcomes such as low blood loss, and less operating time, ultimately leading to less complications and readmissions [19]. Taking this into account implementing SDD may be challenging for hospitals lacking the necessary surgical volume, expertise and infrastructure.

A recent letter by Crivellaro and Tamborino “From Crisis to Innovation: The impact of COVID-19 on Outpatient Setting in Robotic Urologic Surgery” [29] offers important context supporting the feasibility of SDD following RAPN. Using data from the Epic Cosmos dataset, the authors highlight a clear, post-pandemic shift toward outpatient management in robotic urologic procedures, including RAPN and RARP. This transition, accelerated by the need to preserve hospital capacity during COVID-19, reflects growing institutional acceptance of outpatient pathways and aligns with broader adoption of minimally invasive platforms such as the SP robotic system. While the data do not distinguish between surgical techniques or robotic platforms, the large scale of the analysis suggests that outpatient RAPN is becoming more accepted across a range of institutions.

Patient satisfaction and autonomy are also crucial components of successful SDD pathways. Studies have shown that some patients may experience anxiety or discomfort with early discharge, even when medically appropriate [20]. Therefore, it is essential to incorporate shared decision making into the discharge planning process, ensuring patients are well-informed, supported, and comfortable with the plan. This is further supported by findings from a recent study assessing decision regret in patients undergoing SDD after robot-assisted partial prostatectomy, which showed that while the majority of patients reported no regret and would choose the same option again, a notable minority experienced regret, often associated with inadequate pain control, and socioeconomic factors [30]. These insights highlight the importance of individualized discharge planning and proactive postoperative support to optimize patient experience.

Given the advancements in surgical technology and techniques, postoperative care, and patient safety protocols, there is growing interest in SDD. As surgeons become adept with robotic technologies and the evidence supporting SDD increases, it is crucial to evaluate how best to implement SDD practices safely and effectively. Developments in ERAS protocols are essential to supporting SDD. ERAS protocols are designed to streamline recovery processes through evidence-based practices that can significantly decrease the length of stay and enhance postoperative outcomes [31].

Innovation in surgical techniques also stand as a critical factor in enhancing the feasibility of SDD. The use of the retroperitoneal approach might help in increase the adoption of SDD after RAPN. This technique minimizes the risk of intra-abdominal organ injury, provides direct access to the renal hilum, and can result in faster postoperative recovery, reduced complications, and early mobilization [32]. One of the critical advancements is the refinement of robotic surgical systems. The Da Vinci Single Port (SP) system is a notable innovation facilitating less invasive approaches. This system allows for smaller incision and greater manoeuvrability within restricted anatomical spaces. One study indicates that SP RAPN provides comparable outcomes to MP procedures, while also reducing opioid consumptions and enhancing cosmetic results [33, 34]. Abaza et al., compared the outcomes of different urological surgeries using both SP and MP systems, and found that SP surgery is feasible for common urological procedures and allows for a shorter length of stay, and less postoperative pain [35]. Another study also found that SP surgery was associated with a shorter length of stay, but longer warm ischemia times and higher transfusion rates compared to MP [36]. Although cost-specific comparisons between SP and MP RAPN are limited, insights from other robotic procedures, such as robotic-assisted prostatectomy, indicates that SP systems generally incur higher consumable and instrumentation costs. These increased costs are often offset by shorter hospital stays and reduced hospitalization costs, resulting in overall costs that are comparable between SP and MP platforms [37].

Moreover, enhanced remote post-operative recovery care can be potentially leveraged to increase the adaptation of SDD RAPN. As such, telemedicine is emerging as cost-effective and efficient solutions for postoperative follow-up, allowing clinicians to remotely monitor recover while minimizing the need for in-person visits. Along with wearable technologies can also provide better postoperative care by providing real-time data on patients’ postoperative recovery. Devices such as wrist-mounted accelerometers and pedometers and demonstrated feasibility in tracking physical activity, offering valuable insights into early mobilization and functional recovery. These tools may help detect early complications and reduce readmissions [38]. Complementing these tools, AI driven chatbots represent a promising innovation in digital postoperative care. In urology, chatbots can guide patients through their recovery by delivering personalized reminders, medication schedules, wound care instruction, and basic symptom triage. However, barriers such as limited access to high-speed internet, digital illiteracy and language or socioeconomic disparities must be addressed to ensure equitable access [39, 40].

Despite growing interest in SDD following RAPN, the available literature remains limited in both scope and quality. The studies included in this review are mostly retrospective, center-specific, which restricts the generalizability of the findings. Additionally, the studies reflect outcomes from specialized, high-performing surgical units, often led by experienced surgeons. As a result, the data may not reflect outcomes achievable in more typical clinical environments, where surgical volume and resources vary significantly.

Another challenge is the lack of uniform reporting standards across studies. Definitions of key outcomes such as discharge failure, postoperative complications, and follow-up protocols differ widely, making meaningful comparisons difficult. The absence of standardized ERAS protocols also complicates interpretation as it is unclear which specific perioperative strategies contribute to successful SDD. Future studies should strive to establish standardized reporting outcomes to aid in data aggregation and multi-site studies.

The literature also offers limited insight into how institutional infrastructure, staffing, or perioperative logistics influence the success of SDD. Without this context, it is unclear which findings are tied to replicable protocols, and which are dependent on specific conditions that may not be easily duplicated.