Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions
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Standard polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are established techniques for thetreatment of gastrointestinal tumors. However, resection of submucosal tumors via ESD often results in low rates of microscopicallymargin-negative (R0) resection and high rates of perforation. Endoscopic full thickness resection (EFTR) overcomes this adverse eventand aids in the therapeutic management of complex tumors. Multiple techniques for EFTR have been developed, each with its own advantages and disadvantages. Submucosal tunneling and nonexposed techniques are generally preferable, because the layer of overlying intact mucosa reduces the incidence of intraperitonealcontamination by the gastric fluid and dissemination of the tumor cells. However, adoption of EFTR by endoscopists in clinical practiceremains low. The major challenge seems to be the technical diffculty in performing laparoscopic and/or endoscopic suturing using thecurrently available instruments. We developed a novel robotic endoscopic platform with suturing capabilities to overcome the technical challenges of suturing. Thisplatform allows easy maneuvering and triangulation of the instruments, thus facilitating endoscopic suturing using robotic arms. Our studies have demonstrated that this robotic endoscopic platform with suturing capabilities is an effective and safe method forperforming EFTR with endoscopic suturing.
Abstract
Standard polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are established techniques for thetreatment of gastrointestinal tumors. However, resection of submucosal tumors via ESD often results in low rates of microscopicallymargin-negative (R0) resection and high rates of perforation. Endoscopic full thickness resection (EFTR) overcomes this adverse eventand aids in the therapeutic management of complex tumors. Multiple techniques for EFTR have been developed, each with its own advantages and disadvantages. Submucosal tunneling and nonexposed techniques are generally preferable, because the layer of overlying intact mucosa reduces the incidence of intraperitonealcontamination by the gastric fluid and dissemination of the tumor cells. However, adoption of EFTR by endoscopists in clinical practiceremains low. The major challenge seems to be the technical diffculty in performing laparoscopic and/or endoscopic suturing using thecurrently available instruments. We developed a novel robotic endoscopic platform with suturing capabilities to overcome the technical challenges of suturing. Thisplatform allows easy maneuvering and triangulation of the instruments, thus facilitating endoscopic suturing using robotic arms. Our studies have demonstrated that this robotic endoscopic platform with suturing capabilities is an effective and safe method forperforming EFTR with endoscopic suturing.
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