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

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.