Robotic-assisted compartmental dissection for retroperitoneal sarcoma: a feasibility study on cadavers with the da Vinci Xi system

Vollständiger Abstract

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Abstract Retroperitoneal sarcomas (RPS) pose major technical challenges because of their size, anatomical complexity, and need for multivisceral resection. We evaluated the feasibility of a standardized robotic approach for right- and left-sided retroperitoneal sarcoma (RPS) compartmental resection using the da Vinci Xi system in tumour-free human cadavers. In a two-phase IDEAL-D Stage 0 cadaveric study, two sarcoma surgeons first compared four trocar configurations in two cadavers to identify optimal port templates (Phase 1). Complete six-stage compartmental resection following a standardised protocol was then performed once on each side in a third cadaver (Phase 2). The confirmatory dissection was assessed with a 5-point anatomical reach rating per predefined landmark, an adapted System Usability Scale (SUS), and a structured safety surrogate log. Phase 1 yielded a horizontal suprasymphysial port template for the right side and an oblique xiphoid-to-right-lower-quadrant template for the left. In Phase 2, all six stages were completed bilaterally; all predefined landmarks were reached (pooled median reach 5/5, range 3–5; inter-rater agreement 90%). Three-dimensional visualization and instrument articulation were rated highly, the platform scored 72.5/100 on the System Usability Scale, and no unintended major injury occurred. A robotic platform can reproduce the anatomical exposure required for the six-stage compartmental resection concept in a tumour-free cadaveric model, using side-specific port templates. Because no tumour was present, these findings address anatomical access rather than oncological resection. Investigation in tumour-bearing models is required before clinical evaluation, which must remain restricted to highly selected patients at expert centres.