Kim Sang Hyun, Seo Ye Chan, Keum Bora, Jeon Han Jo, Lee Jae Min, Choi Hyuk Soon, Kim Eun Sun, Jeen Yoon Tae, Lee Hong Sik, Hwang Joo Ha, Chun Hoon Jai
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk Gu, Seoul, 02841, South Korea.
Department of Mechanical Engineering, Korea University, Seoul, South Korea.
Surg Endosc. 2025 Sep 18. doi: 10.1007/s00464-025-12182-6.
Endoscopic submucosal dissection (ESD) is a technically complex procedure associated with prolonged operative duration and a heightened risk of complications. To enhance procedural efficiency and safety, various adjunctive techniques have been introduced, particularly for tissue traction and mucosal defect closure. This study aimed to assess the feasibility and efficacy of a novel robotic dual-function gripper capable of performing both tissue traction and defect approximation in an in vivo model.
A dual-function robotic gripper was developed to facilitate submucosal dissection and post-ESD closure. Comparative experiments were conducted using robot-assisted ESD (RESD) and conventional ESD (CESD) on 24 gastric lesions created in six live pigs. In the RESD group, mucosal defects were closed using the robotic gripper in combination with through-the-scope (TTS) clips, whereas closure in the CESD group was performed using standard TTS clips alone. Primary outcomes included total procedure time, dissection speed, blind dissection rate, and success rate of defect closure. Endoscopic and histological evaluations were conducted on postoperative day 14.
All lesions were resected without adverse events. Specimen sizes were comparable between groups (928.1 ± 74.5 mm vs. 937.2 ± 54.8 mm, p = 0.53). However, the RESD group demonstrated significantly shorter procedure times (10.2 ± 1.7 min vs. 15.8 ± 2.1 min, p < 0.05) and faster dissection speeds (157.6 ± 33.3 mm/min vs. 91.4 ± 23.7 mm/min, p < 0.05). Complete defect closure was achieved in all RESD cases, compared to 66.6% in the CESD group. The RESD group also exhibited fewer clip requirements and superior wound healing, as evidenced by narrower zones of epithelial absence and significantly reduced neovascular and fibroblast infiltration.
The robotic dual-function gripper significantly enhanced technical performance and mucosal healing in gastric ESD within a porcine model, suggesting its potential as an effective adjunct for gastric therapeutic endoscopy.
内镜黏膜下剥离术（ESD）是一项技术复杂的手术，手术时间长且并发症风险高。为提高手术效率和安全性，已引入各种辅助技术，特别是用于组织牵引和黏膜缺损闭合。本研究旨在评估一种新型机器人双功能抓持器在体内模型中进行组织牵引和缺损近似的可行性和有效性。
开发了一种双功能机器人抓持器以促进黏膜下剥离和ESD术后闭合。对6头活猪身上创建的24个胃病变进行了机器人辅助ESD（RESD）和传统ESD（CESD）的对比实验。在RESD组中，使用机器人抓持器结合经内镜（TTS）夹子闭合黏膜缺损，而CESD组仅使用标准TTS夹子进行闭合。主要结果包括总手术时间、剥离速度、盲目剥离率和缺损闭合成功率。术后第14天进行内镜和组织学评估。
所有病变均成功切除，无不良事件发生。两组标本大小相当（928.1±74.5mm对937.2±54.8mm，p=0.53）。然而，RESD组的手术时间明显更短（10.2±1.7分钟对15.8±2.1分钟，p<0.05），剥离速度更快（157.6±33.3mm/分钟对91.4±23.7mm/分钟，p<0.05）。RESD组所有病例均实现了完全缺损闭合，而CESD组为66.6%。RESD组所需夹子也更少，伤口愈合更好，上皮缺失区域更窄，新生血管和成纤维细胞浸润明显减少。
机器人双功能抓持器在猪模型中显著提高了胃ESD的技术性能和黏膜愈合，表明其作为胃治疗性内镜有效辅助工具的潜力。
