A novel robotic arm-assisted endoscopic submucosal dissection platform with augmented traction for gastric neoplasms: a first-in-human prospective pilot study (with videos).

Background and aims: Robotic arm-assisted endoscopic submucosal dissection (R-ESD) facilitates visualization of the submucosal dissection plane and aids complete tumor resection. However, the practicality of a robotic arm for gastric neoplasms remains unclear. This study aimed to evaluate the clinical performance of minimally invasive gastric R-ESD.

Methods: A total of 15 consecutive patients who underwent R-ESD between June 2024 and September 2024 at the Korea University Medical Center were prospectively enrolled and analyzed. The primary outcome was en bloc resection.

Results: All patients underwent both en bloc and R0 resections (100%). The majority of tumors (73.3%) were located in the lower third of the stomach (34.7 ± 5.8 mm) and were diagnosed as adenocarcinoma (53.3%) or low-grade adenoma (47.7%). The mean total procedure time (TPT) was 28.8 min and the median robot-assisted dissection time (RDT) was 14.3 min, achieving a dissection speed of 48.2 mm²/min. Specimen injury was occurred in four cases (26.7%). The robotic arm conducted a median of 3.9 grasps per procedure, with an RDT/TPT ratio of 53.8%. A comparison between lower and middle/upper lesions revealed an increased pattern of RDT, grasps and RDT/TPT ratio. The total NASA-TLX score was strongly correlated with the number of grasps, RDT/TPT ratio and TPT.

Conclusions: R-ESD proved feasible and safe in gastric ESD through high en bloc resection rates and dissection speed. R-ESD holds promise for improving procedural safety and performance through augmented traction.