Endoscopic Submucosal Dissection using Detachable Assistant Robot: Comparative in Vivo Feasibility Study

Aims Appropriate tissue tension and clear visibility of the dissection area by traction are essential for effective and safe endoscopic submucosal dissection (ESD). We developed a robotic assistive traction device for flexible endoscopy, and 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, the incision and dissection speeds were compared between the groups.

Results Sixteen gastric lesions were resected from nine live pigs. In the experienced group, mean incision speed and mucosal dissection speed were higher (3.25 vs. 0.64 cm2/min, P = 0.002; and 3.21 vs. 2.30 cm2/min; P = 0.365, respectively), but without statistical significance in the latter. There was no significant difference between the two groups in the grasp time, which is the time taken to grasp the flap with the robotic arm after pre-cutting. No perforation or major bleeding was reported.

Tab. 1 Outcomes of robotic endoscopic submucosal dissection

Outcomes	Experienced endoscopists group	Novice endoscopists group	P-value
En bloc resection rate, %	100	100
Mean incision speed (cm2/min)	3.25 ± 0.88	0.64 ±0.14	0.002
Mean dissection speed (cm2/min)	3.21 ± 0.75	2.30 ± 0.60	0.365
Major bleeding during procedure, %	0	0

Conclusions The dissection speed gap was significantly reduced as compared to the incision speed gap. It seemed that the beginner’s dissection speed increased significantly with the help of the robot. Our robotic device can provide simple, effective, and safe multidirectional traction and countertraction during ESD. While performing robotic ESD, novices could perform ESD safely and efficiently. We expect our device to help trainees perform ESD in places where ESD education is difficult to obtain. The device must be made smaller, and its safety and efficacy in humans should be assessed in future studies.

Citation: Kim SH, Choi HS, Lee KW et al. OP159 ENDOSCOPIC SUBMUCOSAL DISSECTION USING DETACHABLE ASSISTANT ROBOT: COMPARATIVE IN VIVO FEASIBILITY STUDY. Endoscopy 2021; 53: S64.

Publication History

Article published online:
19 March 2021