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Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot
Khek-Yu Ho1, Soo Jay Phee, Asim Shabbir
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
Background:
Performing endoscopic submucosal dissection (ESD) by using standard endoscopy platforms is technically challenging because of the equipment's lack of dexterity.
Objective:
To explore the feasibility of using the Master and Slave Transluminal Endoscopic Robot (MASTER), a novel robotics-enhanced endosurgical system, to perform ESD.
Design:
ESD was performed on simulated gastric lesions in 5 Erlangen porcine stomach models (ex vivo) and 5 live pigs (in vivo). Performance of ESD by using the MASTER was compared with that using the insulation-tipped (IT) diathermic knife.
Setting:
SMART Laboratory, Advance Surgical Training Centre, National University Hospital, Singapore.
Subjects:
Five Erlangen porcine stomach models and 5 pigs, 5 to 7 months old, each weighing about 35 kg.
Interventions:
ESD.
Main Outcome Measurements:
Lesion resection time, grasper and hook efficacy grade, completeness of resection, and presence of procedure-related perforation.
Results:
In the Erlangen stomach models, 15 simulated lesions from the cardia, antrum, and body were removed en bloc (mean dimension, 37.4 x 26.5 mm) by electrocautery excision using the MASTER. The mean ESD time was 23.9 minutes (range 7-48 minutes). There was no difference in the dissection times of lesions at different locations (P = .449). In the live pigs, the MASTER took a mean of 16.2 minutes (range 3-29 minutes) to complete the ESD of 5 gastric lesions, whereas the IT diathermic knife took 18.6 minutes (range 9-34 minutes). There was no significant difference in the times taken (P = .708). All lesions were excised en bloc; the mean dimensions of lesions resected by the MASTER and the IT diathermic knife were 37.2 x 30.1 mm and 32.78 x 25.6 mm, respectively. The MASTER exhibited good grasping and cutting efficiency throughout. Surgical maneuvers were achieved with ease and precision. There was no incidence of excessive bleeding or stomach wall perforation.
Limitations:
Exploratory study with limited sample size.
Conclusions:
Performing ESD by using the MASTER is feasible.
