Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER).
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.


METHODS
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.


METHODS
SMART Laboratory, Advance Surgical Training Centre, National University Hospital, Singapore.


METHODS
Five Erlangen porcine stomach models and 5 pigs, 5 to 7 months old, each weighing about 35 kg.


METHODS
ESD.


METHODS
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.


CONCLUSIONS
Exploratory study with limited sample size.


CONCLUSIONS
Performing ESD by using the MASTER is feasible.
Ho
Khek-Yu
KY
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
Phee
Soo Jay
SJ
Shabbir
Asim
A
Low
Soon Chiang
SC
Huynh
Van An
VA
Kencana
Andy Prima
AP
Yang
Kai
K
Lomanto
Davide
D
So
Bok Yan Jimmy
BY
Wong
Y Y Jennie
YY
Chung
S C Sydney
SC
D000818:Animals; D004195:Disease Models, Animal; D004210:Dissection / Q000295:instrumentation*; D004564:Electrocoagulation / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D020699:Gastroscopes; D012371:Robotics / Q000295:instrumentation*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013525:Surgical Instruments; D013552:Swine