Endorobotic submucosal dissection using the da Vinci SP system: a 101-case experience in robotic transanal surgery

Endorobotic submucosal dissection (ERSD) using the da Vinci single-port (SP) platform offers high-definition visualization and enhanced precision for the resection of distal colorectal lesions. In contrast, conventional endoscopic submucosal dissection is technically demanding and associated with a steep learning curve. This study aims to evaluate the efficacy, broader applicability, and long-term outcomes of ERSD in a large patient cohort.

We retrospectively analyzed 101 patients who underwent ERSD using the da Vinci SP platform between March 2020 and May 2025. Patient demographics, lesion characteristics, procedural details, pathological findings, and long-term follow-up data were reviewed. The primary objectives were to assess intraoperative and postoperative complications, evaluate the feasibility of en-bloc submucosal dissection, and examine the oncological outcomes associated with the ERSD procedure.

The median age of the cohort was 62.5 years (IQR: 52-70 years), with 56.4% male patients. The median distance from the anal verge was 8 cm (IQR: 6-11 cm, range: 1-24 cm). En-bloc resection was achieved in 96.0% of the cases, with a median procedure time of 73 min (IQR: 53-97). The median length of hospital stay was 0 days. The median specimen size was 19 cm² (IQR: 11-28), with a median greatest dimension of 5 cm (range: 1-18 cm). Final pathology revealed tubulovillous adenoma in 57.4% of the cases, tubular adenoma in 16.7%, and serrated adenoma in 6.0%, adenocarcinoma in 12.9%, neuroendocrine tumor in 1.0%, villous adenoma in 1.0%, and colonic mucosa/scar in 5.0%. No metastases or malignant recurrences were observed during the median follow-up of 22 months in patients with adenocarcinoma. Across the entire cohort, three non-cancer-related deaths occurred during follow-up.

Our experience demonstrates that ERSD is not only safe and feasible but also provides durable results with minimal long-term complications and high rates of en-bloc resection in distal colorectal lesions. These findings support the broader application of ERSD as a viable alternative to the traditional transanal approaches for selected colorectal lesions.