Feasibility and performance evaluation of a robotic steerable endoscopic submucosal dissection knife (with video)

Endoscopic submucosal dissection (ESD) requires high precision and dexterity and poses significant challenges for novice operators. Robotic steerable ESD knives have been developed to improve tip control and reduce the technical difficulties associated with conventional instruments. This study aimed to evaluate the feasibility, efficiency, and safety of a novel robotic-steerable ESD knife using simulated tissue models and to compare procedural outcomes between novice and expert endoscopists. Two experts and two novice endoscopists performed standardized ESD procedures using synthetic gastric tissue models. The experiments compared two modalities, robotic knife-assisted ESD (RESD) and conventional knife-assisted ESD (CESD). Each operator performed five procedures for each method. Performance metrics included total procedure time, submucosal dissection speed, dissection accuracy, and incidence of procedural complications. Twenty RESD and CESD procedures were analyzed. The RESD group demonstrated a significantly shorter total procedure time (30.1 ± 13.1 min) compared with CESD (42.3 ± 17.4 min; P < 0.05). Submucosal dissection speed was also significantly higher in RESD (48.3 ± 7.8 mm²/min) than in CESD (20.2 ± 7.4 mm²/min; P < 0.05). Furthermore, dissection accuracy was markedly higher with RESD than with CESD (91.1 ± 4.9% vs. 75.1 ± 14.1%, P < 0.05). The steerable robotic ESD knife facilitated a more controlled and precise submucosal dissection, particularly aiding novice endoscopists in overcoming technical challenges. These findings indicate that robotic knife-assisted ESD may enhance procedural performance, with pronounced benefits for less-experienced operators.