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Title: Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER)
Authors: Ho, K.-Y.
Phee, S.J.
Shabbir, A.
Low, S.C.
Huynh, V.A.
Kencana, A.P.
Yang, K.
Lomanto, D.
So, B.Y.J.
Wong, Y.Y.J. 
Chung, S.C.S.
Issue Date: Sep-2010
Citation: Ho, K.-Y., Phee, S.J., Shabbir, A., Low, S.C., Huynh, V.A., Kencana, A.P., Yang, K., Lomanto, D., So, B.Y.J., Wong, Y.Y.J., Chung, S.C.S. (2010-09). Endoscopic submucosal dissection of gastric lesions by using a Master and Slave Transluminal Endoscopic Robot (MASTER). Gastrointestinal Endoscopy 72 (3) : 593-599. ScholarBank@NUS Repository.
Abstract: Background: Performing endoscopic submucosal dissection (ESD) by using standard endoscopy platforms is technically challenging because of the equipment's lack of dexterity. Objective: To explore the feasibility of using the Master and Slave Transluminal Endoscopic Robot (MASTER), a novel robotics-enhanced endosurgical system, to perform ESD. Design: ESD was performed on simulated gastric lesions in 5 Erlangen porcine stomach models (ex vivo) and 5 live pigs (in vivo). Performance of ESD by using the MASTER was compared with that using the insulation-tipped (IT) diathermic knife. Setting: SMART Laboratory, Advance Surgical Training Centre, National University Hospital, Singapore. Subjects: Five Erlangen porcine stomach models and 5 pigs, 5 to 7 months old, each weighing about 35 kg. Interventions: ESD. Main Outcome Measurements: Lesion resection time, grasper and hook efficacy grade, completeness of resection, and presence of procedure-related perforation. Results: In the Erlangen stomach models, 15 simulated lesions from the cardia, antrum, and body were removed en bloc (mean dimension, 37.4 × 26.5 mm) by electrocautery excision using the MASTER. The mean ESD time was 23.9 minutes (range 7-48 minutes). There was no difference in the dissection times of lesions at different locations (P = .449). In the live pigs, the MASTER took a mean of 16.2 minutes (range 3-29 minutes) to complete the ESD of 5 gastric lesions, whereas the IT diathermic knife took 18.6 minutes (range 9-34 minutes). There was no significant difference in the times taken (P = .708). All lesions were excised en bloc; the mean dimensions of lesions resected by the MASTER and the IT diathermic knife were 37.2 × 30.1 mm and 32.78 × 25.6 mm, respectively. The MASTER exhibited good grasping and cutting efficiency throughout. Surgical maneuvers were achieved with ease and precision. There was no incidence of excessive bleeding or stomach wall perforation. Limitations: Exploratory study with limited sample size. Conclusions: Performing ESD by using the MASTER is feasible. © 2010 American Society for Gastrointestinal Endoscopy.
Source Title: Gastrointestinal Endoscopy
ISSN: 00165107
DOI: 10.1016/j.gie.2010.04.009
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