A Master-Slave Controlled Flexible Robotic System for Endoscopic Submucosal Dissection: Integrated Endoscope Guidance and Dual-Arm Manipulation (With Video).

BACKGROUND

Endoscopic submucosal dissection (ESD) is limited by unstable visualization, insufficient traction, and the ergonomic burden of manual endoscope manipulation, particularly in the colorectum.

METHODS

We developed EndoDreams, a flexible robotic ESD assistant integrating master-slave control for both dual-arm instrumentation and endoscope guidance (insertion, withdrawal, and rotation). Master-slave responsiveness was quantified in benchtop latency and repeatability tests. In vivo feasibility was evaluated in a porcine, lesion-level randomized study (n = 24; 12 gastric, 12 colorectal), with each lesion resected under robotic assistance using standardized ESD protocols.

RESULTS

Bench testing showed minimal master-slave latency (within 300 ms). In vivo, with comparable lesion sizes (approximately 2.3 cm2), EndoDreams significantly increased dissection efficiency, with shorter dissection time and higher standardized dissection speed, which improved submucosal exposure in both gastric lesions and colorectal lesions. EndoDreams. Safety outcomes suggested a potential benefit for EndoDreams platform, particularly in the colorectal lesions (lower muscular injury and perforation), and in which operator workload (NASA-TLX) was reduced as well.

CONCLUSIONS

The EndoDreams system addresses major limitations in conventional ESD by enabling endoscope delivery and precise, dual-arm tissue handling under a master-slave control framework. The combined benchtop and in vivo validations confirm its feasibility and clinical safety.