Endoscopy Video Forum

V9 - Endoscopic Robotic ESD in a Cadaveric Model

Monday, October 8
5:46 PM - 5:53 PM
Location: Terrace Ballroom 1 (level 400)

Category: Endoscopy Video Forum
Seth A. Gross, MD, Gregory Haber, MD, Mark Pochapin, MD
NYU Langone Health, New York, NY

Background: Endosurgery in gastrointestinal endoscopy is a growing area.  Endoscopic submucosal dissection (ESD)in the United States increases in volume each year.  However, wide spread adoption has been limited by training, technical challenges (such as lack of traction), procedure length, and limited endoscopic tools.

The Flex Robotic System is an operator controlled computer assisted flexible endoscope that enables the physician to easily access and visualize structures within the rectum and sigmoid colon. Visualization is provided by a 3D-HD digital camera incorporated in the distal end of the scope. The Flex Robotic System endoscope also provides 2 accessory channels for compatible flexible instruments which are easily viewed when extended from the distal end of the scope, similar to robotic surgery.

The objective of our study was to assess the feasibility of utilizing the Flex® Robotic System for ESDin the rectum and the sigmoid colon. Ability to gain traction, image stability and quality, instrument triangulation, and ability to close the defect were all assessed, in an endoscopists with no prior ESD experience. 

 Methods:An endoscopist performed ESD in a  cadaver using the Flex Robotic System and Instruments in locations ranging from the anal verge to the recto sigmoid junction. Each dissection had the endoscopist dissect into the submucosal tissue plane and remove the simulated lesion.  Following removal of the lesion, the endoscopist sutured closed the defect.

Results: In the video the endoscopist was able to dissect the target area representing the lesion.  After the lesion was removed the endoscopists was then able to suture the defect closed. The procedure length was under one hour. 

Conclusion: Flexible Robotic Endoscopy Platform demonstrated feasibility for submucosal dissection in the rectum in a cadaveric model and will further be assessed in a clinical setting. This is the first reported experince of a GI endosocpist using this novel platform. This clinical scenario for robotic endoscopic submucosal resection represents the early starting point of robotic endoscopy in the luminal gastrointestinal tract.


Disclosures:
Seth Gross: Boston Scientific – Consultant. Cook – Consultant. CSA Medical – Stockholder/Ownership Interest (excluding diversified mutual funds). Microtech – Advisory Committee/Board Member. Motus GI – Advisory Committee/Board Member. Olympus – Consultant.
Gregory Haber indicated no relevant financial relationships.
Mark Pochapin indicated no relevant financial relationships.

Seth A. Gross

Associate Professor of Medicine, NYU School of Medicine; Chief of Gastroenterology, Tisch Hospital
NYU Langone Medical Center
New York, NY

Seth A. Gross, MD, FACG is an Associate Professor of Medicine at NYU Medical School. He currently Chief of Gastroenterology at Tisch Hospital, which is part of the NYU Langone Medical Center. He is active both locally and nationally in the field of gastroenterology and serves on several committees within the ACG.

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