In Vivo Evaluation of Three Novel Robotics Devices for Dynamic Traction and Suturing in Endoscopic Submucosal Dissection

Aims Endoscopic Submucosal Dissection (ESD) is an effective yet technically challenging procedure for gastrointestinal neoplastic lesions resection. Indeed, ESD is associated with a steep learning curve, extended procedure times, and increased risk of adverse events, especially without a traction strategy. Additionally, large mucosal defects post-ESD can be difficult-to-close, with standard techniques often proving inadequate. Recently, robotics in endoscopy has emerged, making complex tasks more accessible, particularly for less experienced endoscopists. This study aims to evaluate the performance of three novel robotics devices (Endorobotics Co., Ltd., Seoul, Korea) designed to assist in dynamic traction and suturing in ESD.

Methods A prospective, controlled study was conducted using an in vivo stomach porcine model. Three devices were tested: the Alligator and Retractable devices for dynamic traction during ESD, and the Stitch device for post-resection defect closure. A total of six endoscopists, including three experts and three non-experts, participated in the study. Each endoscopist performed two ESD procedures (one with each traction device) and two closures (both using the same suturing device). Performance parameters, including traction-assisted ESD and suturing quality, were assessed using a five-point Likert scale. Statistical analysis was conducted to compare the performance between expert and non-expert groups.

Results Both the Alligator and Retractable devices demonstrated consistent and reliable performance across skill levels, with no significant difference in overall scores between non-expert and expert endoscopists (Alligator: 16.00 vs 15.33, p=0.57; Retractable: 14.33 vs 15.00, p=0.63). The Stitch device, however, showed superior results in facilitating defect closure, with non-experts achieving significantly higher scores than experts (Stitch: 17.33 vs 14.67; p=0.005).

Conclusions The Alligator and Retractable devices provided comparable performance for both expert and non-expert endoscopists, demonstrating ease of use and adaptability. The Stitch device notably facilitated defect closure for non-experts, highlighting its potential to reduce the learning curve for complex suturing after ESD. Overall, robotics could improve the accessibility of ESD, particularly for less experienced endoscopists [1] [2] [3].

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

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Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025