title: Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope.
abstract: OBJECTIVE
  One of the challenges in performing endoscopic submucosal dissection (ESD) is the lack of counter traction during submucosal dissection. MASTER (Master and Slave Transluminal Endoscopic Robot) was designed to allow performance of complex endoluminal procedures using two arms with excellent control. This study aimed to compare the performance of ESD between endoscopists and novices using MASTER.
  
  
  METHODS
  This is a prospective study comparing the differences in performing ESD using MASTER in an ex vivo porcine stomach model among individuals with or without experience in surgery and endoscopy. Multiple standardized lesions of 20 mm(2) were pre-marked on an ex vivo porcine stomach. Each participant received basic training in controlling MASTER before the ESD procedure. The operative time and size of specimen obtained by each participant were noted.
  
  
  RESULTS
  Nine individuals (three ESD expert endoscopists, three ESD non-expert endoscopists, and three non-clinician novices) participated in the experiment. All participants completed the ESD procedure for en bloc resection of standardized lesions using EndoMASTER without perforation. The mean times (mean ± SD) taken by ESD expert endoscopists, ESD non-expert endoscopists, and novices to complete Robotic ESD were 122 ± 58 s, 203 ± 150 s, and 561 ± 496 s, respectively. There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242). When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085).
  
  
  CONCLUSIONS
  There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER. The use of MASTER enabled the novice without endoscopy experience to complete the ESD procedure.
authors.affiliation: CUHK Jockey Club Minimally Invasive Surgical Skills Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Philip WaiYan
authors.initials: PW
authors.lastname: Chiu
authors.affiliation: School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore.
authors.forename: Soo Jay
authors.initials: SJ
authors.lastname: Phee
authors.affiliation: Solent Centre for Digestive Diseases, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Bhandari
authors.affiliation: Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.affiliation: Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ohya
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Jennie
authors.initials: J
authors.lastname: Wong
authors.affiliation: CUHK Jockey Club Minimally Invasive Surgical Skills Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: Carmen Cy
authors.initials: CC
authors.lastname: Poon
authors.affiliation: Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore ; Division of Gastroenterology and Hepatology, University Medical Cluster, National University Health System, Singapore, Singapore.
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho