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• W2066600889 abstract "Background and Aims: Performing endoscopic submucosal dissection (ESD) with standard endoscopic equipments is technically challenging due to limited degrees of freedom for maneuvering the tools. We developed a dexterous robotics-enhanced endosurgical system that could potentially overcome the technical hurdles. This study explores the feasibility of using the system in ESD and evaluated its performance vis-à-vis that of conventional endoscopy. Methods: The system comprises a master controller, a telesurgical workstation, and a slave robotic manipulator. The master is attached to the wrists and fingers of the operator through an array of sensors and joints. The slave comprises 2 manipulators - a grasper and a mono-polar diathermy hook which are separately inserted through the operating channels (2.8 mm, 3.7 mm diameters) of the gastroscope. Movements of the operator are detected by sensors and actuated into force signals driving the manipulators. The experiments were first conducted on 5 Erlangen porcine stomachs before evaluation of the system's performance in 2 live pigs. For comparison, ESD was also performed using conventional endoscopy. Gastric lesions measuring 20 mm were marked with needle knife before submucosal injection of 40 ml normal saline and 2 ml 0.04% indigo carmine solution. Dissection was carried out either using the robotics-controlled grasper and hook or the IT knife. Outcome measures were lesion resection time, grasper and hook efficacy, completeness of resection, and presence of procedure-related perforation. Results: In study on Erlangen stomachs, 15 lesions located at the cardia, antrum, or body of stomach were successfully resected by the robotics system. All lesions were resected in a single piece under good grasping and retraction tension. Mean dimension of the resected specimens was 37.4 × 26.5 mm. Mean resection time was 23.9 min (8-48 min). There was no difference between resection times of lesions at different locations. In live pigs, the robotics system took an average 23.5 min (18-29 min) to complete the ESD. This compares with a mean dissection time of 16 min (9-23 min) taken by the conventional system using IT knife. All lesions were resected enbloc. Mean dimension of the specimens resected by the robotics system was 35.8 × 27.6 mm; that dissected by the IT knife averaged 39.5 × 27.5 mm. There was no case of perforation. Conclusion: ESD is feasible and safe using the robotics-enhanced endosurgical system. Although at this stage, no advantage over the conventional method is obvious in ESD, we believe the system would perform better once endoscopists become more accustomed to its usability and functionalities." @default.
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• W2066600889 date "2009-04-01" @default.
• W2066600889 modified "2023-09-26" @default.
• W2066600889 title "Endoscopic Submucosal Dissection of Gastric Lesions Using a Through-the-Scope Intuitively Controlled Robotics-Enhanced Manipulator System" @default.
• W2066600889 doi "https://doi.org/10.1016/j.gie.2009.03.291" @default.
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