CURRENT STATE AND FUTURE PERSPECTIVES OF ENDOSCOPIC FULL-THICKNESS RESECTION AND ROBOTIC ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

Endoscopic full-thickness resection (EFTR) is categorized as exposed and non-exposed EFTR. In exposed EFTR, a full circumferential incision is made in the area surrounding the lesion to perform full-thickness resection first, with subsequent full-thickness closure of the defect. There are several options for defect closure, including the PolyLoop-and-clips method and endoscopic suturing. In non-exposed EFTR, the lesion base is closed using a dedicated full-thickness closure device, followed by full-thickness removal of the lesion. Exposed EFTR allows tumor resection regardless of tumor size, and it may result in higher R0 resection rate compared to non-exposed EFTR. However, a secure closure is essential to avoid peritoneal contamination and tumor dissemination after exposed EFTR. Although non-exposed EFTR can minimize these risks, the maximum size of the lesion that can be resected is limited by the size of the dedicated closure device, resulting in a substantial number of incomplete resections.

Many companies aiming at developing robotic surgical platforms have been emerging in the United States. Currently, several robotic surgical platforms for both laparoscopic and flexible endoscopic surgery are commercially available. In our prospective randomized study, robotic-assisted endoscopic submucosal dissection (ESD) resulted in significantly shorter procedure time, higher en-bloc resection rate, and lower perforation rate than conventional ESD. Newly developed flexible robotic surgical platforms are equipped with the latest robotic technology for the dedicated flexible endoscope and articulating surgical devices, which allows bimanual control of the surgical tools and potentially improves the precision and safety of flexible endoscopic surgery.