eP717 - EndoRobotic Submucosal Dissection: A Game-Changing Innovation for Complex Colorectal Lesions

Purpose/Background: Background: Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique that allows en-bloc resection of gastrointestinal lesions, reducing recurrence risk compared to traditional endoscopic mucosal resection (EMR). However, ESD is technically challenging due to the need for precision control in the submucosal space. Novel robotic platforms like the Da Vinci SP system can facilitate ESD by providing improved ergonomics and visualization with a wristed robotic scope and 3D imaging. This allows for more precise submucosal dissection. In this study, we report on our experience with a new approach: single-port endorobotic submucosal dissection (ERSD) for colorectal lesions using a semiflexible robotic platform. This novel ERSD technique aims to leverage robotics to enable the resection of complex distal colon and rectal neoplasms that would be difficult with standard flexible endoscopes.Methods/Interventions:

Methods: We retrospectively reviewed the medical records of patients who underwent endorobotic submucosal dissection surgery with the Da Vinci SP platform from 2020 to 2023. Patients’ demographics, lesion characteristics, pathology, outcomes, post-operation complications, and recurrence rate on follow up colonoscopy were reviewed and reported. The primary endpoint was the successful completion of submucosal dissection and en-bloc resection.Results/Outcomes:

Results: A total of 40 patients underwent ERSD, median age was 62.5 (51.7-68.2) years, with a median body mass index of 28.1 (24.6-32.6) kg/m2, 65% were male, and 82% of patients had ASA (American Society of Anesthesiology) categories 2 or 3. The median lesion size was 43.5 (35-60) mm and was located 10 (6.2-11.7) cm from the anal verge. The median procedure time was 81.5(53-99.5) minutes. All 40 dissections were successfully resected in an en-bloc (100%) fashion. The improved visualization and control with the robotic platform allowed for easier defect closure compared to conventional ESD. No intraoperative complications or mortality were reported, and 85% of patients were discharged on the same day of the procedure. Urinary retention was observed in one patient and one patient had late bleeding without an active source in endoscopy for which three units of blood were transfused. The pathology results were as follows: 50% tubulovillous adenoma, 22.5% adenocarcinoma, 17.5% tubular adenoma, 5% sessile serrated adenoma, and 5% villous adenoma. High-grade dysplasia was seen in 60% of patients. No recurrence was observed in 22 patients who had follow-up colonoscopy after 6 months.Conclusion/

Discussion:

Conclusion: Single port semiflexible robotic platform facilitating endorobotic submucosal dissection (ERSD) is safe and feasible for the management of colorectal neoplasia, allowing for a high rate of en-bloc resection. Compared to conventional ESD, the robotic platform may shorten dissection time, however, future comparative studies are required. More broadly, the use of robotics for ESD has the potential to represent a paradigm shift in the field. By improving ergonomics and visualization, robotic ESD could enable broader adoption of these techniques by non-expert endoscopists to perform challenging procedures that would otherwise be infeasible with standard flexible endoscopes. Further advances in flexible robotic technology may continue to expand the applications of this approach."Table 1. Patients' characteristics, Surgical and Pathology Outcome

figure 1. Resection procedure and final specimen
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