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

Abstract

Abstract Purpose 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 human cadavers. Methods 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. Results 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. Conclusion Robotic multivisceral compartmental resection for RPS is technically feasible in a cadaveric model and reproduces the standardized six-stage dissection concept using reproducible side-specific port templates. As a single-centre Stage-0 proof of concept, these findings support — without yet justifying — structured training and cautious in vivo evaluation in carefully selected patients at specialized centres.