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Dual-function robotic gripper for traction and closure in gastric endoscopic submucosal dissection: an in vivo porcine model study (with video)

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Abstract

Objectives

Endoscopic submucosal dissection (ESD) is a technically complex procedure associated with prolonged operative duration and a heightened risk of complications. To enhance procedural efficiency and safety, various adjunctive techniques have been introduced, particularly for tissue traction and mucosal defect closure. This study aimed to assess the feasibility and efficacy of a novel robotic dual-function gripper capable of performing both tissue traction and defect approximation in an in vivo model.

Methods

A dual-function robotic gripper was developed to facilitate submucosal dissection and post-ESD closure. Comparative experiments were conducted using robot-assisted ESD (RESD) and conventional ESD (CESD) on 24 gastric lesions created in six live pigs. In the RESD group, mucosal defects were closed using the robotic gripper in combination with through-the-scope (TTS) clips, whereas closure in the CESD group was performed using standard TTS clips alone. Primary outcomes included total procedure time, dissection speed, blind dissection rate, and success rate of defect closure. Endoscopic and histological evaluations were conducted on postoperative day 14.

Results

All lesions were resected without adverse events. Specimen sizes were comparable between groups (928.1 ± 74.5 mm2 vs. 937.2 ± 54.8 mm2, p = 0.53). However, the RESD group demonstrated significantly shorter procedure times (10.2 ± 1.7 min vs. 15.8 ± 2.1 min, p < 0.05) and faster dissection speeds (157.6 ± 33.3 mm2/min vs. 91.4 ± 23.7 mm2/min, p < 0.05). Complete defect closure was achieved in all RESD cases, compared to 66.6% in the CESD group. The RESD group also exhibited fewer clip requirements and superior wound healing, as evidenced by narrower zones of epithelial absence and significantly reduced neovascular and fibroblast infiltration.

Conclusion

The robotic dual-function gripper significantly enhanced technical performance and mucosal healing in gastric ESD within a porcine model, suggesting its potential as an effective adjunct for gastric therapeutic endoscopy.

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Acknowledgements

ENDOROBOTICS collaborated in the development of the robotic gripper used in this study by providing technical support during device prototyping and refinement.

Funding

This research was supported by a grant of the Korea Health Technology R and D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant number: HI22C0935). This work was supported by the Technology development Program (RS-2023-00321839) funded by the Ministry of SMEs and Startups (MSS, Korea) and by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT) (RS-2023-00228946).

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Author notes

  1. Sang Hyun Kim and Ye Chan Seo have contributed equally to the manuscript.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk Gu, Seoul, 02841, South Korea

    Sang Hyun Kim, Bora Keum, Han Jo Jeon, Jae Min Lee, Hyuk Soon Choi, Eun Sun Kim, Yoon Tae Jeen, Hong Sik Lee & Hoon Jai Chun

  2. Department of Mechanical Engineering, Korea University, Seoul, South Korea

    Ye Chan Seo

  3. Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA

    Joo Ha Hwang

Authors
  1. Sang Hyun Kim
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Corresponding author

Correspondence to Bora Keum.

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Conflict of interest

Hyuk Soon Choi, Bora Keum, and Hoon Jai Chun hold stocks for ENDOROBOTICS. Joo Ha Hwang is a consultant for Olympus, Medtronic, Boston Scientific, Micro-Tech, Fujifilm, ERBE, LumenDi, Neptune, Noah, and ENDOROBOTICS. Sang Hyun Kim, Ye Chan Seo, Han Jo Jeon, Jae Min Lee, Eun Sun Kim, Yoon Tae Jeen, and Hong Sik Lee have no conflicts of interest or financial ties to disclose.

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Kim, S.H., Seo, Y.C., Keum, B. et al. Dual-function robotic gripper for traction and closure in gastric endoscopic submucosal dissection: an in vivo porcine model study (with video). Surg Endosc (2025). https://doi.org/10.1007/s00464-025-12182-6

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