Robot-assisted versus conventional endoscopic submucosal dissection: a systematic review and meta-analysis.

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2026-06-16 eCollection Date: 2026-01-01 DOI:10.1177/17562848261458700

Menghan Wang, Yan Zhao, Yijun Chen, Wenhai Wang

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引用次数: 0

Abstract

Background: Robot-assisted endoscopic submucosal dissection (RA-ESD) has been developed to address the ergonomic and technical limitations of conventional ESD (C-ESD). However, the current evidence base remains limited and is predominantly derived from preclinical studies.

Objectives: To systematically evaluate the comparative efficacy and safety of RA-ESD versus C-ESD.

Design: Systematic review and meta-analysis.

Data sources and methods: A comprehensive literature search was conducted in major electronic databases in accordance with the PRISMA 2020 Statement. Comparative studies assessing RA-ESD versus C-ESD were included. Continuous outcomes were pooled using mean differences (MDs), and dichotomous outcomes were analyzed using odds ratios (ORs), both with 95% confidence intervals (CIs). Random-effects models were applied for all primary analyses.

Results: Twelve studies (n = 581) were included, of which the majority were preclinical. In exploratory pooled analyses, RA-ESD was associated with shorter submucosal dissection time (min) (MD -6.62, 95% CI -9.38 to -3.86) and overall procedure time (min) (MD -6.00, 95% CI -9.13 to -2.86). Dissection speed (mm²/min) was higher with RA-ESD (MD 35.80, 95% CI 8.98 to 62.62), although heterogeneity was substantial. The blind dissection rate (%) was lower in the RA-ESD group (MD -22.64, 95% CI -31.49 to -13.78). RA-ESD was associated with a higher en bloc resection rate (OR 6.44, 95% CI 1.05 to 39.39) and a lower risk of muscular injury (OR 0.18, 95% CI 0.06 to 0.53). No significant difference in perforation was observed.

Conclusion: RA-ESD demonstrates promising technical advantages over C-ESD, including improved procedural efficiency and reduced technical difficulty, without an apparent increase in major adverse events. However, given that the current evidence is predominantly preclinical and characterized by substantial heterogeneity, these findings should be interpreted as preliminary and hypothesis-generating. Further well-designed clinical studies are required to confirm the real-world effectiveness, safety, and long-term outcomes of RA-ESD.

Trial registration: PROSPERO registration number: CRD420261336534.

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机器人辅助与常规内镜粘膜下剥离：一项系统综述和荟萃分析。

背景：机器人辅助内镜下粘膜剥离（RA-ESD）的发展是为了解决传统ESD （C-ESD）的人体工程学和技术局限性。然而，目前的证据基础仍然有限，主要来自临床前研究。目的：系统评价RA-ESD与C-ESD的比较疗效和安全性。设计：系统回顾和荟萃分析。数据来源和方法：按照PRISMA 2020声明在各大电子数据库进行全面的文献检索。包括评估RA-ESD与C-ESD的比较研究。使用平均差异（md）汇总连续结果，使用优势比（ORs）分析二分类结果，均采用95%置信区间（ci）。所有初步分析均采用随机效应模型。结果：纳入12项研究（n = 581），其中大部分为临床前研究。在探索性合并分析中，RA-ESD与更短的粘膜下剥离时间（min）（MD -6.62, 95% CI -9.38至-3.86）和总体手术时间（min）（MD -6.00, 95% CI -9.13至-2.86）相关。RA-ESD组的解剖速度（mm2/min）更高（MD为35.80,95% CI为8.98 ~ 62.62），但存在很大的异质性。RA-ESD组的盲剥离率（%）较低（MD -22.64, 95% CI -31.49 ~ -13.78）。RA-ESD与较高的整体切除率（OR 6.44, 95% CI 1.05 ~ 39.39）和较低的肌肉损伤风险（OR 0.18, 95% CI 0.06 ~ 0.53）相关。穿孔无明显差异。结论：RA-ESD相对于C-ESD具有明显的技术优势，提高了手术效率，降低了技术难度，且重大不良事件发生率没有明显增加。然而，鉴于目前的证据主要是临床前的，并且具有实质性的异质性，这些发现应该被解释为初步的和假设产生的。需要进一步精心设计的临床研究来证实RA-ESD的实际有效性、安全性和长期结果。试验注册：普洛斯彼罗注册号：CRD420261336534。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.