A novel robotic arm–assisted endoscopic submucosal dissection platform with augmented traction for gastric neoplasms: a first-in-human prospective pilot study (with videos) - 25/10/25

Doi : 10.1016/j.gie.2025.09.012

Han Jo Jeon, MD, PhD, Bora Keum, MD, PhD ^⁎ , Bomee Lee, MD, MS, Sanghyun Kim, MD, PhD, Hyuk Soon Choi, MD, PhD, Jae Min Lee, MD, PhD, Eun Sun Kim, MD, PhD, Yoon Tae Jeen, MD, PhD, Hong Sik Lee, MD, PhD, Hoon Jai Chun, MD, PhD

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea

^∗ Corresponding author: Bora Keum, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea. Division of Gastroenterology and Hepatology Department of Internal Medicine Korea University College of Medicine 73, Goryeodae-ro, Seongbuk-gu Seoul 02841 Republic of Korea

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Abstract

Background and Aims

Robotic arm–assisted endoscopic submucosal dissection (R-ESD) facilitates visualization of the submucosal dissection plane and aids complete tumor resection. However, the practicality of a robotic arm for gastric neoplasms remains unclear. This study aimed to evaluate the clinical performance of minimally invasive gastric R-ESD.

Methods

A total of 15 consecutive patients who underwent R-ESD between June 2024 and September 2024 at the Korea University Medical Center were prospectively enrolled and analyzed. The primary outcome was en bloc resection.

Results

All patients underwent both en bloc and R0 resections (100%). The majority of tumors (73.3%) were located in the lower third of the stomach (34.7 ± 5.8 mm) and were diagnosed as adenocarcinoma (53.3%) or low-grade adenoma (47.7%). The mean total procedure time (TPT) was 28.8 minutes and the median robot-assisted dissection time (RDT) was 14.3 minutes, achieving a dissection speed of 48.2 mm ² /min. Specimen injury was occurred in 4 cases (26.7%). The robotic arm conducted a median of 3.9 grasps per procedure, with an RDT/TPT ratio of 53.8%. A comparison between lower and middle/upper lesions revealed an increased pattern of RDT, grasps, and RDT/TPT ratio. The total NASA-TLX score was strongly correlated with the number of grasps, RDT/TPT ratio, and TPT.

Conclusions

robotic arm–assisted endoscopic submucosal dissection (R-ESD) proved feasible and safe in gastric endoscopic submucosal dissection through high en bloc resection rates and dissection speed. R-ESD holds promise for improving procedural safety and performance through augmented traction.

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