Introduction <p>Robotic-assisted surgery has advanced reconstructive procedures, including peritoneal flap vaginoplasty (PFV), where both single-port and multi-port robotic systems are used. However, there remains debate regarding comparative efficacy, safety, and overall patient benefits of these two approaches. This paper aims to evaluate the outcomes of single-port versus multi-port robotic systems in PFV, focusing on operative efficiency and patient safety.</p> Methods <p>We retrospectively reviewed all patients who underwent robotic-assisted PFV between September 2021 and May 2024. All procedures were led by the same surgical team. Demographic and postoperative data were collected. Operative details, such as the type of robotic system used (single-port vs. multi-port), procedure length, and estimated costs were also recorded. Statistical analysis was conducted using IBM SPSS software. P-values of &lt; 0.05 were considered statistically significant.</p> Results <p>A total of 47 patients underwent full-depth PFV. 24 patients underwent PFV with the assistance of a multiport robot and 23 with a single-port robot. Groups did not differ demographically (<i>p</i> &gt; 0.05). Mean operative time in the multiport cohort was 264&#xa0;min compared to 204&#xa0;min in the single-port cohort (<i>p</i> &lt; 0.001). The single-port approach yielded a mean estimated cost savings of $6,960 (<i>p</i> &lt; 0.001) There was no statistically significant difference in acute postoperative complications between cohorts.</p> Conclusion <p>This retrospective review demonstrates that single-port robotic-assisted peritoneal flap vaginoplasty (PFV) is associated with significantly shorter operative times and lower total costs compared to multi-port procedures. These findings suggest that the single-port approach may offer enhanced surgical efficiency without compromising patient safety.</p>