Dual-function robotic gripper for traction and closure in gastric endoscopic submucosal dissection: an in vivo porcine model study (with video).

Abstract

Objectives: 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.

Methods: 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.

Results: All lesions were resected without adverse events. Specimen sizes were comparable between groups (928.1 ± 74.5 mm² vs. 937.2 ± 54.8 mm², 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 mm²/min vs. 91.4 ± 23.7 mm²/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.

Conclusion: 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.