Sa1891 THE COMPARATIVE STUDY OF ROBOT ASSISTED ENDOSCOPIC SUBMUCOSAL DISSECTION : ANIMAL MODEL STUDY

Abstract

Endoscopic submucosal dissection has become as effective treatment for the early gastrointestinal neoplasm. But Endoscopic submucosal dissection (ESD) is a difficult procedure. Recently, auxiliary devices have been developed to alleviate the difficulties of ESD. We also developed new endoscopic robotic manipulator. The purpose of this study is to evaluate the efficacy and safety of new endoscopic robot manipulator in vitro animal study A novel robotic manipulator is composed of a control panel and a working arm, which grasp and move objects at the end of endoscope. A total of 40 porcine stomachs were used for the test and an in-vitro test bed was developed to simulate the endoscopic surgical environment for this study. Endoscopists were classified as expert or novice. As a preliminary work, operation time and perforation rate of the experts and novices were recorded when ESD was performed by the conventional method. (C-Expert group, C-Novice group). The same experiment was performed using robotic manipulator (R-Expert group, R-Novice group). The average operation time of the four groups was 11.3±4.7(R-E group), 11.3±4.7(C-E group), 26.4±12.2(R-N group) and 26.7±10.9(C-N group). There was no significant difference in operation time between conventional ESD method and proposed method by using robotic manipulator in both groups. But experimental ESDs using the robotic manipulator showed a short learning curve in novice group. When robotic assisted method was used, one case of perforation occurred during the preocedure. Perforation rate of the robot manipulator assisted method was significantly lower than that of the conventional method in the novice group. (10% vs 60%, P=0.057) The robotic manipulator, which can perform ESD showed feasible result comparing with conventional ESD. The robotic manipulator improved the safety of ESD in the case of the novice endoscopist.