Purpose Orbital surgery benefits from instrumentation that offers gentle tissue manipulation with exceptionally high accuracy and precision. This is where robotic surgery offers an advantage. We aimed to evaluate a robotic-assisted surgical system’s feasibility, safety and outcome in assisting periocular tumour clearance.

Methods Pre-clinical (IDEAL phase 0) cadaveric studies were performed to optimise positioning, setting and approach to anterior orbital resection using the DaVinci XI system (intuitive surgical). We proceeded to first-in-human (IDEAL phase 1), robotic-assisted resection.

Results Four patients with advanced periocular tumours (mean age of 63 years) were included. One patient underwent simultaneous parotidectomy and lymph node clearance. Clear resection of the primary tumour was achieved in all patients. Patients were followed-up for at least one year, and three remained disease-free. One patient with pre-existing extra-orbital disease developed metastatic disease five months post-op. All patients preserved vision peri-operatively, with no patient suffered any adverse events related to the robotic device.

Conclusion Our series highlights the potential advantage of three-dimensional optics, multi-directional instrumentation and motion scaling technology to achieve globe-sparing tumour resection in advanced periocular tumours. However, further robotic instrumentation development is required for orbital surgery.