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A novel flexible auxiliary single-arm transluminal endoscopic robot facilitates endoscopic submucosal dissection of gastric lesions (with video)

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Abstract

Background

Using conventional endoscope to perform endoscopic submucosal dissection (ESD) is difficult because of the one-handed operation and blind dissection caused by gravity. Poor visualization of the submucosal plane causes ESD to be associated with a high risk of bleeding and perforation. This study aimed to develop a novel ESD-assistive robot system and to evaluate its efficacy.

Methods

A novel flexible auxiliary single-arm transluminal endoscopic robot (FASTER) was developed. A total of 36 artificial lesions in ex vivo porcine stomachs were removed using the FASTER-assisted ESD method (n = 18) and the conventional ESD method (n = 18). Lesions were 2 cm or 4 cm in diameter, located on the anterior and posterior walls of the antrum. Primary outcome measurements were dissection time and dissection speed.

Results

The dissection time in FASTER-assisted ESD was significantly shorter than that in conventional ESD (7 min vs 13 min, p = 0.012), mainly because of the faster dissection speed (148.6 vs 97.0 mm2/min, p = 0.002). The total procedure time in FASTER-assisted ESD was shorter than that in conventional ESD, but the difference was not significant (16 min vs 24 min, p = 0.252). Complete en bloc resection was achieved in all lesions. No perforations were detected. The FASTER exhibited the ability of regrasp, multidirectional traction, and proper tension control during ESD.

Conclusion

FASTER significantly increased the dissection speed by providing proper traction and achieving good submucosal vision. This new device is expected to facilitate ESD in clinical practice.

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Acknowledgements

Thanks to our colleaguesYuxiang Zhang, Zhenjun Wang, Xue Wei, Jingyi Li, Tao Cong, Qihui Geng, Jing Xie, Chen Lu, Xiaoli Jia, Huimu Chen, Yingying Qi, Wenwen Fu, Mei Xu, Donghui Zhai, Wenxue Qi, Fujia Liu, Min Zhang, Cheng Peng, Qian Li, Dawei Shen, Minjuan Lin, Juan Wang, Wenlin Zhang, and Chen Qiao for assistance during the study.

Funding

This study was supported by National Key R&D Program of China (2018YFB1307700), Key Research and Development Program of Shandong Province (2018CXGC1209), Taishan Scholars Program of Shandong Province and National Clinical Research Center for Digestive Diseases supporting technology project (2015BAI13B07), and Natural Science Foundation of Shandong Province, China (ZR2020LZL003).

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Authors and Affiliations

  1. Department of Gastroenterology, Qilu Hospital, Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, China

    Xiao-Xiao Yang, Shi-Chen Fu, Rui Ji, Li-Xiang Li, Yan-Qing Li & Xiu-Li Zuo

  2. Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital, Shandong University, Jinan, 250012, China

    Yan-Qing Li & Xiu-Li Zuo

  3. Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, 250012, China

    Yan-Qing Li & Xiu-Li Zuo

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  1. Xiao-Xiao Yang
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  2. Shi-Chen Fu
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Correspondence to Yan-Qing Li or Xiu-Li Zuo.

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Xiao-Xiao Yang, Shi-Chen Fu, Rui Ji, Li-Xiang Li, Xiu-Li Zuo, and Yan-Qing Li have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary Video exhibits the composition and movement of the flexible auxiliary single-arm transluminal endoscopic robot (FASTER), and uses the FASTER in an ex vivo porcine gastric endoscopic submucosal dissection (MP4 153043 kb)

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Yang, XX., Fu, SC., Ji, R. et al. A novel flexible auxiliary single-arm transluminal endoscopic robot facilitates endoscopic submucosal dissection of gastric lesions (with video). Surg Endosc 36, 5510–5517 (2022). https://doi.org/10.1007/s00464-022-09194-x

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