Colonic endoscopic submucosal dissection using a novel robotic system.

Abstract

111 Background: Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). We developed a robotic assistive traction device for colonoscopy.This is a preclinical animal study to evaluate the performance of colorectal ESD using novel robotic system. Methods: Experienced endoscopist performed ESD on ex vivo porcine colon ten times using a robot and ten times by the conventional method. The outcome measures were operating time (from starting incision to finishing dissection), completeness of resection, procedure-related adverse events, and limitations of arm manipulation in a narrow working space as assessed by counting the frequency of blind cutting.We also conducted an in vivo feasibility study on live pig. Results: Total of twenty colonic lesions were resected from ex vivo porcine colon. The submucosal dissection speed was significantly faster in robotic ESD than in conventional ESD (P = 0.002). Adverse events such as perforation were also significantly higher in the conventional group. In the in vivo feasibility study, robot was attached to the colonoscope and inserted into the proximal colon. ESD was performed successfully. Conclusions: When the robot was assisting in the ESD procedure, the dissection speed improved significantly. Our robotic device can thus provide simple, effective, and safe multidirectional traction during colonic ESD.