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Endoscopy 2012; 44(07): 690-694
DOI: 10.1055/s-0032-1309404
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection of gastric lesions by using a master and slave transluminal endoscopic robot: an animal survival study[1]

Z. Wang
1   School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
,
S. J. Phee
1   School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
,
D. Lomanto
2   Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore
,
R. Goel
2   Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore
,
P. Rebala
3   Asian Institute of Gastroenterology, Hyderabad AP, India
,
Z. L. Sun
1   School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore
,
S. Trasti
4   Department of Comparative Medicine, National University of Singapore
,
N. Reddy
3   Asian Institute of Gastroenterology, Hyderabad AP, India
,
J. Y. Y. Wong
5   Department of Medicine, National University Health System, Singapore
,
K. Y. Ho
5   Department of Medicine, National University Health System, Singapore
› Author Affiliations
Further Information

Publication History

Submitted 19 October 2011

Accepted after revision 28 February 2012

Publication Date:
21 June 2012 (online)

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Commentaire de travail de Z. Wang et al, pp. 690Endoscopy 2012; 44(07): 718-718
DOI: 10.1055/s-0032-1309989

Background and study aims: The feasibility of performing endoscopic submucosal dissection (ESD) using the Master and Slave Transluminal Endoscopic Robot (MASTER), a robotics-enhanced surgical system, has been shown in our previous study. This study aimed to further explore, in an animal survival study, the 2-week outcome of using MASTER to perform ESD.

Patients and methods: In this prospective study, ESD was performed on five female pigs (weighing 32.4 – 36.8 kg) under general anesthesia using the MASTER. The animals were observed for 2 weeks before being humanely killed for necropsy examination. The main outcome measures were completeness of resection, procedure-related complications, and survival at 2 weeks.

Results: The procedure was successfully completed in all five pigs. It took a mean of 21.8 minutes (range 6 – 39 minutes) to complete the ESD of each gastric lesion. All lesions were excised en bloc; the average dimension of the lesions was 77 mm (range 25 – 104 mm). One pig sustained a small intraoperative perforation which was identified and successfully clipped. After completion of the ESD procedures, all pigs survived well for 2 weeks. Necropsy was performed, with intraoperative gastroscopy identifying all the ESD sites as healed. Histopathologic examination showed all ESD sites had healed with partial epithelialization. Microbiological tests of the peritoneal fluid showed only microbes typically found in pigs.

Conclusion: Performing ESD with MASTER was feasible and safe in this 2-week animal survival study.

1 Note: This work was presented at Digestive Disease Week (DDW) in Chicago, 2011.


 

  • References

  • 1 Yahagi N, Fujishiro M, Kakushima N et al. Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type). Dig Endosc 2004; 16: 34-38
    CrossrefPubMedGoogle Scholar
  • 2 Gotoda T. A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 2005; 3: 71-73
    CrossrefPubMedGoogle Scholar
  • 3 Chung IK, Lee JH, Lee SH et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009; 69: 1228-1235
    CrossrefPubMedGoogle Scholar
  • 4 Takeuchi Y, Uedo N, Iishi H et al. Endoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos). Gastrointest Endosc 2007; 66: 186-193
    CrossrefPubMedGoogle Scholar
  • 5 Ho KY, Phee SJ, Shabbir A et al. Endoscopic submucosal dissection of gastric lesions using a Master and Slave Transluminal Endoscopic Robot (MASTER). Gastrointest Endosc 2010; 72: 593-599
    CrossrefPubMedGoogle Scholar
  • 6 Phee SJ, Low SC, Sun ZL et al. Robotic system for no-scar gastrointestinal surgery. Int J Med Robot 2008; 4: 15-22
    CrossrefPubMedGoogle Scholar
  • 7 Sun ZL, Ang RY, Lim EW et al. Enhancement of a master-slave robotic system for natural orifice transluminal endoscopic surgery. Ann Acad Med Singapore 2011; 40: 223-228
    PubMedGoogle Scholar
  • 8 Phee SJ, Sun ZL, Wang Z et al. The future of transluminal surgery. Exp Rev Med Devices 2011; 8: 669-671
    CrossrefPubMedGoogle Scholar
  • 9 Zühlke HV, Lorenz EMP, Straub EM et al. Pathophysiologie und Klassifikation von Adhäsionen. Langenbecks Arch Chir Suppl II Verh Dtsch Chir 1990; 345: 1009-1016
    PubMedGoogle Scholar
  • 10 Spaun GO, Zheng B, Swanström LL. A multitasking platform for natural orifice translumenal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Surg Endosc 2009; 23: 2720-2727
    CrossrefPubMedGoogle Scholar
  • 11 Clayman RV, Box GN, Abraham JB et al. Rapid communication: transvaginal single-port NOTES nephrectomy: initial laboratory experience. J Endourol 2007; 21: 640-644
    CrossrefPubMedGoogle Scholar
  • 12 Rex DK, Khashab M, Raju GS et al. Insertability and safety of a shapelocking device for colonoscopy. Am J Gastroenterol 2005; 100: 817-20
    CrossrefPubMedGoogle Scholar
  • 13 Thompson CC, Ryou M, Soper NJ et al. Evaluation of a manually driven, multitasking platform for complex endoluminal and natural orifice transluminal endoscopic surgery applications (with video). Gastrointest Endosc 2009; 70: 121-125
    CrossrefPubMedGoogle Scholar
  • 14 Spaun GO, Zheng B, Martinec DV et al. Bimanual coordination in natural orifice transluminal endoscopic surgery: comparing the conventional dual-channel endoscope, the R-Scope, and a novel direct-drive system. Gastrointest Endosc 2009; 69: e39-e45
    CrossrefPubMedGoogle Scholar