Simplified robot-assisted endoscopic submucosal dissection for esophageal and gastric lesions: a randomized controlled porcine study (with videos) - 14/06/22

Doi : 10.1016/j.gie.2022.01.004

Rui Ji, MD, PhD ¹, Jia-Lin Yang, MSE ², Xiao-Xiao Yang, MD ¹, Shi-Chen Fu, MD ¹, Li-Xiang Li, PhD ³, Yan-Qing Li, MD, PhD ¹, Xiu-Li Zuo, MD, PhD ^1,^⁎
¹ Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
² Robo Medical Robotics Institute, Shenzhen, China
³ Laboratory of Translational Gastroenterology, Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Shandong University, Jinan, China

^∗Reprint requests: Xiu-Li Zuo, Qilu Hospital, Shandong University, No 107, Wenhuaxi Rd, Jinan, China 250012.Qilu HospitalShandong UniversityNo 107Wenhuaxi RdJinan250012China

Abstract

Background and Aims

Effective countertraction is a main challenging issue in endoscopic submucosal dissection (ESD). Several countertraction methods have been developed to address this issue. The aim of this study was to compare the efficacy of ESD using a novel simplified robot, the flexible auxiliary single-arm transluminal endoscopic robot (FASTER), with a traditional technique.

Methods

This was a prospective, randomized animal study. Forty-eight ESDs in 6 pigs were carried out at 8 different locations (gastric antrum, gastric body, lower esophagus, and middle esophagus) by the conventional method (n = 24) and by the FASTER-assisted method (n = 24). The primary outcomes were total procedure time, dissection time, and rate of direct-vision dissection. Secondary endpoints were completeness of en-bloc resection and adverse event rate.

Results

The total procedure time was significantly shorter in FASTER-assisted ESD than in conventional ESD (18.8 vs 32.8 minutes; P < .001). In contrast to the median direct-vision dissection rate of 73% with conventional ESD, the FASTER-assisted group had a significantly higher rate of 96% (P < .001). The number of sites of muscular damage was significantly lower using the FASTER-assisted method than the conventional method (6 vs 21, respectively; P = .018). This improvement was more apparent in esophageal lesions compared with gastric lesions.

Conclusions

This study demonstrated that using a simplified robot during ESD is technically feasible and enables the endoscopist to dynamically use countertraction. This device could significantly reduce procedure time compared with conventional ESD techniques.

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Abbreviations : ESD, FASTER, IQR

Plan

Methods

Study design and sample size calculation

FASTER-assisted ESD versus conventional ESD

Subgroup outcomes of the total procedure time

Operability of FASTER

Discussion

DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided by the National Key R&D Program of China (2018YFB1307700), Natural Science Foundation of Shandong Province, China (ZR2020LZL003), Key Research and Development Program of Shandong Province (2018CXGC1209), and Taishan Scholars Program of Shandong Province and National Clinical Research Center for Digestive Diseases supporting technology project (2015BAI13B07).

DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure sex balance in the selection of nonhuman subjects. The author list of this article includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.