Colonic endoscopic submucosal dissection using a novel robotic system (with video).

Chiu, Philip Wai Yan; Ho, Khek Yu; Jay, Soo

BACKGROUND AND AIMS One of the difficulties in performing endoscopic submucosal dissection (ESD) is the lack of retraction during submucosal dissection. The development of the EndoMaster EASE System aims to enhance safety and efficacy of ESD through 2 flexible robotic arms for tissue retraction and dissection. This is a preclinical animal study to evaluate performance of colorectal ESD using latest version of the EndoMaster EASE System. METHOD The latest version of the EndoMaster EASE System consisted of an independently designed flexible platform with build-in endoscopic imaging system and 3 working channels, 2 for passage of robotic arms and one for accessories. In this animal study, the outcome measures included operating time (from starting incision to finishing dissection), completeness of resection, procedure-related adverse events as well as limitation of arms manipulation in narrow working space as assessed by counting the frequency of blind cutting. RESULTS A total of 5 ESD procedures were performed in a 66.7kg porcine model under general anesthesia. The mean operative time was 73.8 minutes, and the mean size of specimen resected was 1340 mm2. There was no perforation, although profuse bleeding was encountered during one of the robotic ESD procedures. CONCLUSIONS The current preclinical study confirmed the feasibility of performing colorectal ESD using the latest version of EndoMaster EASE System. The system was also tested for the ability to tackle with adverse events including bleeding and perforation. This provided important preclinical experience for clinical trial.