Endorobotic submucosal dissection using the da Vinci SP system: a 101-case experience in robotic transanal surgery

BACKGROUND: Endorobotic submucosal dissection (ERSD) using the da Vinci single-port (SP) platform offers high-definition visualization and enhanced precision for the resection of distal colorectal lesions. In contrast, conventional endoscopic submucosal dissection is technically demanding and associated with a steep learning curve. This study aims to evaluate the efficacy, broader applicability, and long-term outcomes of ERSD in a large patient cohort. METHODS: We retrospectively analyzed 101 patients who underwent ERSD using the da Vinci SP platform between March 2020 and May 2025. Patient demographics, lesion characteristics, procedural details, pathological findings, and long-term follow-up data were reviewed. The primary objectives were to assess intraoperative and postoperative complications, evaluate the feasibility of en-bloc submucosal dissection, and examine the oncological outcomes associated with the ERSD procedure. RESULTS: (IQR: 11-28), with a median greatest dimension of 5 cm (range: 1-18 cm). Final pathology revealed tubulovillous adenoma in 57.4% of the cases, tubular adenoma in 16.7%, and serrated adenoma in 6.0%, adenocarcinoma in 12.9%, neuroendocrine tumor in 1.0%, villous adenoma in 1.0%, and colonic mucosa/scar in 5.0%. No metastases or malignant recurrences were observed during the median follow-up of 22 months in patients with adenocarcinoma. Across the entire cohort, three non-cancer-related deaths occurred during follow-up. CONCLUSION: Our experience demonstrates that ERSD is not only safe and feasible but also provides durable results with minimal long-term complications and high rates of en-bloc resection in distal colorectal lesions. These findings support the broader application of ERSD as a viable alternative to the traditional transanal approaches for selected colorectal lesions.