Robotic-assisted traction and closure during colorectal endoscopic submucosal dissection

Background and Aims: Endoscopic submucosal dissection (ESD) is a technically challenging procedure that can be associated with a lengthy procedure duration and high risk of adverse events. A robotic gripper device for tissue traction and closure during endoscopic procedures was recently approved by the U.S. Food and Drug Administration. In this video, we demonstrate the use of this device to assist with traction during ESD. Methods: The robotic platform consists of an operating driver unit, a controller, and the robotic gripper arm. The robotic arm is mounted on the distal tip of the endoscope. The robotic arm's multidegree range of motion is directed through the controller and adjusted to provide tissue tension during ESD. Results: A 60-year-old man underwent flexible sigmoidoscopy for a 60-mm granular mixed laterally spreading tumor in the rectum. A circumferential mucosal incision was made with a water-pressure injection ESD knife. After this, the robotic gripper arm was used to provide traction throughout the procedure to optimize tissue tension and visualization during dissection. The en bloc-resected specimen measured 75 × 70 mm in size. Final histopathology was a tubulovillous adenoma with high-grade dysplasia. Conclusions: We demonstrate the use of a robotic arm to assist with traction during ESD. This robotic platform allowed real-time tissue manipulation and dynamic adjustment, optimizing tissue tension and visualization during ESD and tissue apposition during mucosal closure.