The feasibility of endoscopic submucosal dissection (ESD) using the master and slave
transluminal endoscopic robot (MASTER) has been shown in our previous studies [1]
[2]
[3]. Compared with gastric ESD, esophageal ESD remains challenging because of technical
difficulties and risks [4]
[5]. The aim of this study was to evaluate the feasibility of using MASTER to perform
esophageal ESD.
The new version of MASTER was used for esophageal ESD on one pig. The MASTER was redesigned
to facilitate performance of ESD within a narrow working space. The main outcomes
were: operating time, completeness of resection, and adverse events. The secondary
outcomes included: clearance of operative field and limitation of robot arm manipulation
in the narrow working space, assessed by counting the number of episodes of blind
cutting. For the purpose of comparison with esophageal ESD, one gastric and one colonic
ESD were performed by the same operator.
All procedures were successfully completed ([Table 1]; [Figs. 1 – 3]; [Video 1]). It took 15, 63, and 45 minutes to complete the esophageal, gastric, and colonic
ESDs, respectively. All lesions were excised en bloc; the specimen sizes were: 20 × 20,
50 × 45, and 35 × 35 mm, respectively. The dissection speeds were: 20.9, 28.0, and
21.4 mm2/min, respectively. There were no adverse events. The number of episodes of blind
cutting were: 2, 6, and 6 (0.13, 0.10, and 0.13/min).
Table 1
Outcomes of endoscopic submucosal dissection procedures using the MASTER.
|
Procedure 1
|
Procedure 2
|
Procedure 3
|
|
Organ
|
Esophagus
|
Stomach
|
Colon
|
|
Location
|
Middle thoracic
|
Middle greater curvature
|
Sigmoid
|
|
Completion
|
Complete
|
Complete
|
Complete
|
|
Operation time, minutes
|
15
|
63
|
45
|
|
Size of specimen, mm
|
20 × 20
|
50 × 45
|
35 × 35
|
|
Dissection speed, mm2/min
|
20.9
|
28
|
21.4
|
|
En bloc/piecemeal
|
En bloc
|
En bloc
|
En bloc
|
|
Uncontrolled bleeding
|
No
|
No
|
No
|
|
Perforation
|
No
|
No
|
No
|
|
Episodes of blind cutting
|
2
|
6
|
6
|
Fig. 1 Esophageal endoscopic submucosal dissection (ESD) being performed using the newly
developed MASTER endoscopic platform.
Fig. 2 Endoscopic view of the post-endoscopic submucosal dissection (ESD) ulcer.
Fig. 3 The resected specimen, which measured 20 × 20 mm.
Video 1: Esophageal endoscopic submucosal dissection (ESD) being performed. After
marking and injections had been performed, the proximal mucosal incision was created.
The mucosa was lifted by the grasper and the submucosa was dissected in parallel with
circumferential mucosal cutting. The distal mucosal incision was finally completed
and the specimen was resected.
In contrast to gastric and colonic ESD, the traction of the grasper during esophageal
ESD tended to align with the long axis because of the narrow working space. There
was no difference comparing esophageal against gastric and colonic ESD in terms of
the speed of dissection, the rate of complete resection, the occurrence of adverse
events, and the number of episodes of blind cutting.
In conclusion, performing esophageal ESD using the MASTER was feasible with a certain
degree of adjustment for the narrow working space.
Endoscopy_UCTN_Code_TTT_1AO_2AG
