Endoscopic submucosal dissection (ESD) is an increasingly effective endoscopic technique worldwide. Robot-assisted ESD is a novel technique that enables complex movements by providing an extended range of motions to improve the visualization of the surgical field and provide better cosmetic surgical outcomes. We aim to systematically review and meta-analyze the efficacy and safety of robot-assisted ESD.

We followed the PRISMA guidelines for meta-analysis. We included studies reporting on patients with GI tumors or masses who underwent robot-assisted ESD. Our primary outcomes were en bloc resection rates, recurrence rates, and complications like bleeding and perforation. Secondary outcomes encompassed the length of the procedure, lesion size, complete resection rates, and duration of hospital stay. We used Joanna Briggs Institute's (JBI) Critical Appraisal Tool and the ROBINS-I tool for quality assessment. Continuous data were pooled as means, while dichotomous data were pooled as proportions with a 95% confidence interval (95% CI).

Eight studies consisting of two clinical trials, three cohort studies, and three case reports with 115 participants were included. The en bloc resection rate was 97.400%, 95% CI (0.901, 0.993). According to the complete resection outcome, the rate was 82.900%, 95% CI (0.722, 0.900). Procedure time and Hospital Stay were 82.030 min 95% CI: 48.130, 115.940), 1.640 days 95% CI (-0.180, 3.740), respectively. The intraoperative bleeding rate was 1.800%, 95% CI (0.004, 0.068).

Our systematic review and meta-analysis demonstrated robot-assisted endoscopic submucosal dissection's potential efficacy and safety. However, future high-quality studies with larger sample sizes and extended follow-up periods are needed to support our initial findings further. Robot-assisted ESD may be promising in dealing with larger lesions, which are often challenging with conventional ESD.