A NOVEL RETRACTABLE ROBOTIC DEVICE FOR COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

초록

Background and Aims Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. Methods An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. Results Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 vs. 34.3±8.3; P<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 vs. 18.1±4.7; P<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8±3.4% vs. 35.1±3.9%; P<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. Conclusions The dissection speed and safety profile improved significantly with the retractable robot-assisted ESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.