A novel robotic arm-assisted endoscopic submucosal dissection platform with augmented traction for gastric neoplasms: a first-in-human prospective pilot study (with videos).

BACKGROUND AND AIMS: Robotic arm-assisted endoscopic submucosal dissection (R-ESD) facilitates visualization of the submucosal dissection plane and aids complete tumor resection. However, the practicality of a robotic arm for gastric neoplasms remains unclear. This study aimed to evaluate the clinical performance of minimally invasive gastric R-ESD.

METHODS

A total of 15 consecutive patients who underwent R-ESD between June 2024 and September 2024 at the Korea University Medical Center were prospectively enrolled and analyzed. The primary outcome was en bloc resection.

RESULTS

All patients underwent both en bloc and R0 resections (100%). The majority of tumors (73.3%) were located in the lower third of the stomach (34.7 ± 5.8 mm) and were diagnosed as adenocarcinoma (53.3%) or low-grade adenoma (47.7%). The mean total procedure time (TPT) was 28.8 minutes and the median robot-assisted dissection time (RDT) was 14.3 minutes, achieving a dissection speed of 48.2 mm2/min. Specimen injury occurred in 4 cases (26.7%). The robotic arm conducted a median of 3.9 grasps per procedure, with an RDT/TPT ratio of 53.8%. A comparison between lower and middle/upper lesions revealed an increased pattern of RDT, grasps, and RDT/TPT ratio. The total NASA-TLX score was strongly correlated with the number of grasps, RDT/TPT ratio, and TPT.

CONCLUSIONS

R-ESD proved feasible and safe in gastric endoscopic submucosal dissection through high en bloc resection rates and dissection speed. R-ESD holds promise for improving procedural safety and performance through augmented traction.