title: Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER).
abstract: 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.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
authors.forename: Khek-Yu
authors.initials: KY
authors.lastname: Ho
authors.forename: Soo Jay
authors.initials: SJ
authors.lastname: Phee
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
authors.forename: Soon Chiang
authors.initials: SC
authors.lastname: Low
authors.forename: Van An
authors.initials: VA
authors.lastname: Huynh
authors.forename: Andy Prima
authors.initials: AP
authors.lastname: Kencana
authors.forename: Kai
authors.initials: K
authors.lastname: Yang
authors.forename: Davide
authors.initials: D
authors.lastname: Lomanto
authors.forename: Bok Yan Jimmy
authors.initials: BY
authors.lastname: So
authors.forename: Y Y Jennie
authors.initials: YY
authors.lastname: Wong
authors.forename: S C Sydney
authors.initials: SC
authors.lastname: Chung
mesh_terms: 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