Endoscopic submucosal dissection (ESD) represents a crucial advancement in minimally invasive gastroenterological interventions, enabling precise excision of early neoplasms [1, 2]. However, its technical intricacy and steep learning curve impede widespread implementation [3, 4]. Endorobotic submucosal dissection (ERSD) emerges as a solution, incorporating robotic technology to enhance dexterity and providing superior three-dimensional visualization, potentially mitigating ESD's limitations [5].
A 75-year-old male with a significant sigmoid colon lesion underwent ERSD. The GelPOINT Path® (Applied Medical Resources Corp., Rancho Santa Margarita, CA), a flexible ring-shaped transanal access platform positioned at the anal verge, enables pneumorectum establishment and enhanced instrument access. The Da Vinci SP (Intuitive Surgical, Sunnyvale, CA) surgical system was employed, which deploys articulating instruments and a 3D camera through a single 25-mm port. Meticulous submucosal dissection was performed utilizing the robotic system's precision, with a spatula facilitating controlled dissection in the submucosal plane. Complete lesion excision was achieved.
The postoperative course was uneventful, with the patient transferred to recovery in stable condition. Histopathology confirmed a tubulovillous adenoma exhibiting high-grade dysplasia, with dysplasia-free cauterized margins. This case exemplifies ERSD's efficacy in managing complex colonic lesions, demonstrating its potential for optimizing outcomes through minimally invasive techniques and its adaptability in colonic navigation.
This case demonstrates ERSD's advancement in minimally invasive surgery, integrating robotic technology to enhance dexterity and 3D visualization. Utilizing the Da Vinci SP system and GelPOINT Path platform showcases technical progress, enabling precise dissection and improved navigation. The emphasis on clear margins in histopathology underscores its prognostic importance. Overall, this exemplifies surgical evolution towards improved outcomes via technological innovation.
Supplementary Information
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Author contribution
A.U., A.K., S.E., and E.G. made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; A.U., A.K., S.E., and E.G drafted the work or revised it critically for important intellectual content; A.U., A.K., S.E., and E.G approved the version to be published; and A.U., A.K., S.E., and E.G agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding
This study did not receive any grants or financial assistance.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Conflicts of interest
AU, AK, TS, and SE declare no conflicts of interest.EG is a consultant for Vascular Technology, DiLumen, Boston Scientific, and Olympus.The authors declare no competing interests.
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Supplementary Materials
Data Availability Statement
No datasets were generated or analysed during the current study.