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Robot-assisted gastric endoscopic submucosal dissection significantly improves procedure time at challenging dissection locations

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Abstract

Background

Endoscopic submucosal dissection (ESD) is the standard treatment for early malignant stomach lesions. However, this procedure is technically demanding and carries a high complication risk. The level of difficulty in performing ESD is influenced by the location of the lesion. In our study, we aimed to investigate and analyze the effectiveness of robot-assisted ESD for lesions situated in challenging locations within the stomach.

Methods

We developed a gastric simulator that could be used to implement various gastric ESD locations. An EndoGel (Sunarrow, Tokyo, Japan) was attached to the simulator for the dissection procedures. Robot-assisted or conventional ESD was performed at challenging or easy locations by two ESD-trainee endoscopists.

Results

The procedure time was remarkably shorter for robotic ESD than conventional dissection at challenging locations (6.2 vs. 10.2 min, P < 0.05), mainly due to faster dissection (220.3 vs. 101.9 mm2/min, P < 0.05). The blind dissection rate was significantly lower with robotic ESD than with the conventional method (17.6 vs. 35.2%, P < 0.05) at challenging locations.

Conclusion

The procedure time was significantly shortened when robot-assisted gastric ESD procedures were performed at challenging locations. Therefore, our robotic device provides simple, effective, and safe multidirectional traction for endoscopic submucosal dissection at challenging locations, thereby reducing difficulty of the procedure.

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (Grant No. NRF-2020R1A2C4002621). This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2022R1A2C2006986). This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Healthy Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant [HI22C0935]).

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Author notes

  1. Sang Hyun Kim and Taebin Kwon are co-first authors.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk gu, Seoul, 02841, South Korea

    Sang Hyun Kim, Hyuk Soon Choi, Han Jo Jeon, Eun Sun Kim, Bora Keum, Yoon Tae Jeen & Hoon Jai Chun

  2. Department of Mechanical Engineering, Korea University, Seoul, South Korea

    Taebin Kwon, Chanwoo Kim & Seonghyeon Won

  3. Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA

    Hyuk Soon Choi & Joo Ha Hwang

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  1. Sang Hyun Kim
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Corresponding author

Correspondence to Hyuk Soon Choi.

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Disclosures

Hyuk Soon Choi, Bora Keum, and Hoon Jai Chun hold stocks for ENDOROBOTICS. Joo Ha Hwang is a consultant for Olympus, Medtronic, Boston Scientific, Micro-Tech, LumenDi, Steris and ENDOROBOTICS. Sang Hyun Kim, Taebin Kwon, Chanwoo Kim, Seonghyeon Won, Han Jo Jeon, Eun Sun Kim, and Yoon Tae Jeen have no conflicts of interest or financial ties to disclose.

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Kim, S.H., Kwon, T., Choi, H.S. et al. Robot-assisted gastric endoscopic submucosal dissection significantly improves procedure time at challenging dissection locations. Surg Endosc 38, 2280–2287 (2024). https://doi.org/10.1007/s00464-024-10743-9

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