Using Robotic Endoscopic Platforms to Perform Gastric Endoscopic Submucosal Dissection – Benefits and Future Development

Abstract

Previously, the gold standard surgery for early gastric cancer was gastrectomy. This practice has changed radically with the introduction of advanced endoscopic resection techniques, including endoscopic submucosal dissection (ESD). Compared with traditional gastrectomies, the minimally invasive nature of ESDs allows patients to recover faster and experience less postoperative pain. Nevertheless, procedurists performing gastric ESDs are hampered by the limitations of current endoscopic instruments. The lack of degrees of freedom of existing endoscopic instruments renders it challenging for procedurists to achieve triangulation of instruments, optimal retraction of tissues, and adequate exposure of the operating field. Robotic endoscopic platforms solve these challenges by providing robotic end-effectors with high degrees of freedom. This review analyzes the benefits of robotic endoscopic platforms in reducing the learning curve, procedure times, and complication rates in performing gastric ESD. The review also explores future development of robotic endoscopic platforms that can enhance the efficacy and efficiency of gastric ESD, such as the development of adjunct endoscopic instruments to create and close full-thickness incisions, incorporating haptic feedback into robotic endoscopic platforms, and establishing a structured training program for procedurists.