Gastric endoscopic submucosal dissection using a detachable assistant robot

Abstract

Background: Effective traction and counter-traction for visualizing the dissection plane in endoscopic submucosal dissection (ESD) is difficult to be achieved with a conventional endoscope. We developed a robotic assistive traction device for flexible endoscopy that provides multi-directional traction during ESD. We compared its safety and efficiency in ESD between experienced and novice endoscopists.

Methods: Robotic ESD was performed by experienced and novice endoscopist groups (n = 2, each). The outcomes included time to complete each ESD step, total procedure time, size of the dissected mucosa, rate of en bloc resection, and major adverse events. Furthermore, incision and dissection speeds were compared between groups.

Results: Twenty gastric lesions were resected from nine live pigs. The submucosal incision speed was significantly faster in the expert group than in the novice group (P = 0.002). There was no significant difference in the submucosal dissection speed between the groups (P = 0.365). No complications were reported in either group.

Conclusions: When the robot was assisting in the ESD procedure, the dissection speed improved significantly, especially in the novice surgeons. Our robotic device can provide simple, effective, and safe multidirectional traction during ESD.