Advertisement

Colonic endoscopic submucosal dissection using a novel robotic system (with video)

Published:September 25, 2020DOI:https://doi.org/10.1016/j.gie.2020.09.042

      Background and Aims

      One of the difficulties in performing endoscopic submucosal dissection (ESD) is the lack of retraction during submucosal dissection. The development of the EndoMaster EASE System (EndoMaster Pte Ltd, Singapore) aims to enhance the safety and efficacy of ESD through 2 flexible robotic arms for tissue retraction and dissection. This is a preclinical animal study to evaluate the performance of colorectal ESD using the latest version of the EndoMaster EASE System.

      Methods

      The latest version of the EndoMaster EASE System consists of an independently designed, flexible platform with a built-in endoscopic imaging system and 3 working channels, 2 for the passage of robotic arms and 1 for accessories. In this animal study, the outcome measures were operating time (from starting incision to finishing dissection), completeness of resection, procedure-related adverse events, and limitations of arm manipulation in a narrow working space as assessed by counting the frequency of blind cutting.

      Results

      Five ESD procedures were performed in a 66.7-kg porcine model with the animal under general anesthesia. The mean operative time was 73.8 minutes, and the mean size of the specimen resected was 1340 mm2. There was no perforation, although profuse bleeding was encountered during 1 robotic ESD procedure.

      Conclusions

      The current preclinical study confirmed the feasibility of performing colorectal ESD using the latest version of the EndoMaster EASE System. The system was also tested for the ability to manage adverse events including bleeding and perforation. This study provided important preclinical experience for clinical trial.

      Abbreviation:

      ESD (endoscopic submucosal dissection)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tanaka S.
        • Oka S.
        • Kaneko I.
        • et al.
        Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization.
        Gastrointest Endosc. 2007; 66: 100-107
        • Schmoll H.J.
        • Van Cutsem E.
        • Stein A.
        • et al.
        ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making.
        Ann Oncol. 2012; 23: 2479-2516
        • White A.
        • Joseph D.
        • Rim S.H.
        • et al.
        Colon cancer survival in the United States by race and stage (2001-2009): findings from the CONCORD-2 study.
        Cancer. 2017; 123: 5014-5036
        • Wiegering A.
        • Ackermann S.
        • Riegel J.
        • et al.
        Improved survival of patients with colon cancer detected by screening colonoscopy.
        Int J Colorectal Dis. 2016; 31: 1039-1045
        • Ferlitsch M.
        • Moss A.
        • Hassan C.
        • et al.
        Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.
        Endoscopy. 2017; 49: 270-297
        • Maguire L.H.
        • Shellito P.C.
        Endoscopic piecemeal resection of large colorectal polyps with long-term followup.
        Surg Endosc. 2014; 28: 2641-2648
        • Buchner A.M.
        • Guarner-Argente C.
        • Ginsberg G.G.
        Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center.
        Gastrointest Endosc. 2012; 76: 255-263
        • Saito Y.
        • Uraoka T.
        • Yamaguchi Y.
        • et al.
        A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video).
        Gastrointest Endosc. 2010; 72: 1217-1225
        • Maple J.T.
        • Abu Dayyeh B.K.
        • Chauhan S.S.
        • et al.
        Endoscopic submucosal dissection.
        Gastrointest Endosc. 2015; 81: 1311-1325
        • Wang J.
        • Zhang X.H.
        • Ge J.
        • et al.
        Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis.
        World J Gastroenterol. 2014; 20: 8282-8287
        • Ho K.Y.
        • Phee S.J.
        • Shabbir A.
        • et al.
        Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER).
        Gastrointest Endosc. 2010; 72: 593-599
        • Chiu P.W.
        • Phee S.J.
        • Bhandari P.
        • et al.
        Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope.
        Endosc Int Open. 2015; 3: E439-E442
      1. Kiriyama S, Saito Y, Yamamoto S, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy 20121;44:1024-1030. [Erratum in: Endoscopy 2013;45:41.]

        • Hon S.S.
        • Ng S.S.
        • Wong T.C.
        • et al.
        Endoscopic submucosal dissection vs laparoscopic colorectal resection for early colorectal epithelial neoplasia.
        World J Gastrointest Endosc. 2015; 7: 1243-1249
        • Pimentel-Nunes P.
        • Dinis-Ribeiro M.
        • Ponchon T.
        • et al.
        Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline.
        Endoscopy. 2015; 47: 829-854
        • Teoh A.Y.
        • Chiu P.W.
        • Wong S.K.
        • et al.
        Difficulties and outcomes in starting endoscopic submucosal dissection.
        Surg Endosc. 2010; 24: 1049-1054
        • Chiu P.W.
        • Teoh A.Y.
        • Wong V.W.
        • et al.
        Robotic-assisted minimally invasive esophagectomy for treatment of esophageal carcinoma.
        J Robot Surg. 2017; 11: 193-199
        • Chiu P.W.Y.
        • Ng S.S.M.
        • Au S.K.W.
        Transcervical minimally invasive esophagectomy using da Vinci® SP™ Surgical System: a feasibility study in cadaveric model.
        Surg Endosc. 2019; 33: 1683-1686
        • Kantsevoy S.V.
        • Bitner M.
        • Piskun G.
        New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos).
        Surg Endosc. 2016; 30: 3145-3151
        • Kantsevoy S.V.
        • Wagner A.
        • Mitrakov A.A.
        • et al.
        Rectal reconstruction after endoscopic submucosal dissection for removal of a giant rectal lesion.
        VideoGIE. 2019; 4: 179-181
        • Ho K.Y.
        • Phee S.J.
        • Shabbir A.
        • et al.
        Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER).
        Gastrointest Endosc. 2010; 72: 593-599
        • Phee S.J.
        • Reddy N.
        • Chiu P.W.
        • et al.
        Robot-assisted endoscopic submucosal dissection is effective in treating patients with early-stage gastric neoplasia.
        Clin Gastroenterol Hepatol. 2012; 10: 1117-1121
        • Takeshita N.
        • Ho K.Y.
        • Phee S.J.
        • et al.
        Feasibility of performing esophageal endoscopic submucosal dissection using master and slave transluminal endoscopic robot.
        Endoscopy. 2017; 49: E27-E28
        • Wong J.Y.Y.
        • Ho K.Y.
        Robotics for advanced therapeutic colonoscopy.
        Clin Endosc. 2018; 51: 552-557
        • Chan J.Y.K.
        • Tsang R.K.
        • Holsinger F.C.
        • et al.
        Prospective clinical trial to evaluate safety and feasibility of using a single port flexible robotic system for transoral head and neck surgery.
        Oral Oncol. 2019; 94: 101-105
        • Kneist W.
        • Stein H.
        • Rheinwald M.
        Da Vinci single-port robot-assisted transanal mesorectal excision: a promising preclinical experience.
        Surg Endosc. 2020; 34: 3232-3235
        • Zorn L.
        • Nageotte F.
        • Zanne P.
        • et al.
        A novel telemanipulated robotic assistant for surgical endoscopy: preclinical application to ESD.
        IEEE Trans Biomed Eng. 2018; 65: 797-808
        • Turiani Hourneaux de Moura D.
        • Aihara H.
        • Jirapinyo P.
        • et al.
        Robot-assisted endoscopic submucosal dissection versus conventional ESD for colorectal lesions: outcomes of a randomized pilot study in endoscopists without prior ESD experience (with video).
        Gastrointest Endosc. 2019; 90: 290-298
        • Kume K.
        • Sakai N.
        • Ueda T.
        Development of a novel gastrointestinal endoscopic robot enabling complete remote control of all operations: endoscopic therapeutic robot system (ETRS).
        Gastroenterol Res Pract. 2019; : 6909547

      Linked Article

      • Expanding a new frontier: endoscopic submucosal dissection by use of a robotic endoluminal system
        Gastrointestinal EndoscopyVol. 93Issue 5
        • Preview
          Advances in endoscopic techniques have allowed clinicians to perform resection of large colon polyps or early superficial tumors using 2 main techniques—endoscopic submucosal dissection (ESD) and EMR. EMR can be applied for laterally spreading tumors, sessile lesions, and superficial neoplasia in the colon. It is physically limited to a maximal diameter of approximately 20 mm for en bloc resection. ESD has been successfully performed for several indications, including removal of a variety of submucosal lesions throughout the GI tract and for removal of early invasive mucosal-based GI tumors in an en bloc resection.
        • Full-Text
        • PDF