Background and Aims
Endoscopic submucosal dissection (ESD) is considered technically difficult and challenging
using a conventional flexible endoscope, mainly due to the lack of proper countertraction
to expose the submucosal dissection plane. This study aimed to evaluate the feasibility
of a traction method using a dexterous robotic arm in ex vivo gastric ESD.
Methods
ESD was performed in a total of 45 procedures using a portable endoscopic tool handler
(PETH) (n = 30) and using the conventional method (n = 15) at various locations in
the stomach. For each procedure, the performance data were recorded, including the
total procedure time (minutes), incision time (minutes), dissection speed (mm2/minute), and blind dissection rate (%), to enable a comparison of the 2 ESD methods.
Results
The total procedure time was significantly shorter with PETH-ESD than in conventional
ESD (23 vs 36 minutes, P = .011). This result is mainly attributed to the dissection speed, which was significantly
faster, by more than 2.5 times, using the PETH (122.3 ± 76.5 vs 47.5 ± 26.9 mm2/minute, P < .001). The blind dissection rate was greatly decreased in PETH-ESD (0 vs 20%, P < .001). There was no significant difference in the incision time (6.1 ± 5.0 vs 5.5
± 2.9 min, P = .612).
Conclusions
The countertraction method using the PETH significantly improved the dissection speed
and reduced blind dissection by enhancing direct visualization of the submucosal plane.
With the advantages of multidirectional traction, fine tension control, and regrasping,
this new device is expected to improve the performance of ESD and further facilitate
advanced endoscopic procedures.
Abbreviations:
ESD (endoscopic submucosal dissection), PETH (portable endoscopic tool handler)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 18, 2019
Accepted:
November 3,
2019
Received:
May 6,
2019
Footnotes
If you would like to chat with an author of this article, you may contact Dr Lee at [email protected]
DISCLOSURE: All authors disclosed no financial relationships.
Identification
Copyright
© 2020 by the American Society for Gastrointestinal Endoscopy
