{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T21:30:42Z","timestamp":1786397442933,"version":"build-2736575974"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasia but remains technically demanding because of limited traction, lack of triangulation, and high operator workload, contributing to a steep learning curve. We evaluated a novel endoluminal robotic platform designed to provide surgical-like bimanual triangulation, stable traction\/counter-traction, and improved ergonomics while preserving compatibility with standard gastroscopes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The robotic system (Intilume System, Agilis Robotics, Hong Kong, SAR) uses an external positioning cart to drive two 3.5-mm flexible robotic instruments mounted onto a native gastroscope via a cap-and-sheath interface and controlled by compact pen-style motion-tracking controllers enabling seated operation. Available instruments included a bipolar T-knife and a tissue grasper. In a randomized crossover ex vivo porcine stomach study, two gastroenterology fellows without prior ESD experience and two interventional endoscopy fellows with early experience each performed four ESDs (two robotic, two conventional), for a total of 16 procedures. Outcomes included en bloc resection, procedure time, specimen surface area, dissection speed, tissue injury, and operator workload assessed using NASA-TLX, with exploratory OSATS and GEARS evaluations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All procedures were completed (8 robotic, 8 conventional). Robotic ESD achieved 100% en bloc resection versus 75% with conventional ESD (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.47), was significantly faster (14.1\u2009\u00b1\u20094.3 vs 21.6\u2009\u00b1\u20097.6\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), and demonstrated higher dissection speed (36.5\u2009\u00b1\u200923.4 vs 16.3\u2009\u00b1\u200910.1 mm\n                      <jats:sup>2<\/jats:sup>\n                      \/min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05). No muscular injuries occurred with robotic ESD compared with 5\/8 conventional cases; no full-thickness injuries occurred. Operator workload was markedly lower with robotic ESD (NASA-TLX 34.7\u2009\u00b1\u200924.1 vs 75.0\u2009\u00b1\u200915.4;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a randomized ex vivo model, a bimanual endoluminal robotic platform compatible with standard endoscopes demonstrated promising improvements in ESD efficiency, tissue control, and operator ergonomics compared with conventional ESD. These preliminary findings support further development and progression to first-in-human feasibility evaluation, with potential to facilitate ESD skill acquisition pending clinical validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-12972-6","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T21:10:29Z","timestamp":1782940229000},"page":"7234-7242","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel bimanual endoluminal robotic platform compatible with standard gastroscopes for endoscopic submucosal dissection: preclinical feasibility and ergonomic evaluation"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6257-4400","authenticated-orcid":false,"given":"Yung","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Seok","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Firkins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sera","family":"Satoi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikash","family":"Fnu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyungran Justina","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"12972_CR1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/den.12518","volume":"28","author":"H Ono","year":"2016","unstructured":"Ono H, Yao K, Fujishiro M, Oda I, Nimura S, Yahagi N et al (2016) Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 28:3\u201315. https:\/\/doi.org\/10.1111\/den.12518","journal-title":"Dig Endosc"},{"key":"12972_CR2","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1016\/J.CGH.2019.06.008","volume":"18","author":"X Zhang","year":"2020","unstructured":"Zhang X, Ly EK, Nithyanand S, Modayil RJ, Khodorskiy DO, Neppala S et al (2020) Learning curve for endoscopic submucosal dissection with an untutored, prevalence-based approach in the United States. Clin Gastroenterol Hepatol 18:580-588.e1. https:\/\/doi.org\/10.1016\/J.CGH.2019.06.008","journal-title":"Clin Gastroenterol Hepatol"},{"key":"12972_CR3","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1016\/J.GIE.2012.08.024","volume":"76","author":"F Iacopini","year":"2012","unstructured":"Iacopini F, Bella A, Costamagna G, Gotoda T, Saito Y, Elisei W et al (2012) Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves. Gastrointest Endosc 76:1188\u20131196. https:\/\/doi.org\/10.1016\/J.GIE.2012.08.024","journal-title":"Gastrointest Endosc"},{"key":"12972_CR4","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.gie.2013.04.192","volume":"78","author":"N Fukami","year":"2013","unstructured":"Fukami N (2013) What we want for ESD is a second hand! Traction method. Gastrointest Endosc 78:274\u2013276. https:\/\/doi.org\/10.1016\/j.gie.2013.04.192","journal-title":"Gastrointest Endosc"},{"key":"12972_CR5","doi-asserted-by":"publisher","first-page":"673","DOI":"10.5009\/GNL19266","volume":"14","author":"S Abe","year":"2020","unstructured":"Abe S, Wu SYS, Ego M, Takamaru H, Sekiguchi M, Yamada M et al (2020) Efficacy of current traction techniques for endoscopic submucosal dissection. Gut Liver 14:673. https:\/\/doi.org\/10.5009\/GNL19266","journal-title":"Gut Liver"},{"key":"12972_CR6","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/J.GIE.2019.08.014","volume":"91","author":"M Yoshida","year":"2020","unstructured":"Yoshida M, Takizawa K, Nonaka S, Shichijo S, Suzuki S, Sato C et al (2020) Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 91:55-65.e2. https:\/\/doi.org\/10.1016\/J.GIE.2019.08.014","journal-title":"Gastrointest Endosc"},{"key":"12972_CR7","doi-asserted-by":"publisher","DOI":"10.1055\/A-2699-5861","author":"R Zhang","year":"2025","unstructured":"Zhang R, Ji R, Li M, Yang X, Lu J, Lu C et al (2025) Safety and efficacy of traction robot-assisted endoscopic submucosal dissection for early gastric cancer: a randomized pilot trial. Endoscopy. https:\/\/doi.org\/10.1055\/A-2699-5861","journal-title":"Endoscopy"},{"key":"12972_CR8","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/J.GIE.2019.03.016","volume":"90","author":"D Turiani Hourneaux de Moura","year":"2019","unstructured":"Turiani Hourneaux de Moura D, Aihara H, Jirapinyo P, Farias G, Hathorn KE, Bazarbashi A et al (2019) Robot-assisted endoscopic submucosal dissection versus conventional ESD for colorectal lesions: outcomes of a randomized pilot study in endoscopists without prior ESD experience (with video). Gastrointest Endosc 90:290\u2013298. https:\/\/doi.org\/10.1016\/J.GIE.2019.03.016","journal-title":"Gastrointest Endosc"},{"issue":"1","key":"12972_CR9","doi-asserted-by":"publisher","DOI":"10.1038\/S41598-024-63647-Y","volume":"14","author":"J Kim","year":"2024","unstructured":"Kim J, Lee DH, Kwon DS, Park KC, Sul HJ, Hwang M et al (2024) Efficacy of robot arm-assisted endoscopic submucosal dissection in live porcine stomach (with video). Sci Rep 14(1):17367-. https:\/\/doi.org\/10.1038\/S41598-024-63647-Y","journal-title":"Sci Rep"},{"issue":"7","key":"12972_CR10","doi-asserted-by":"publisher","first-page":"5510","DOI":"10.1007\/S00464-022-09194-X","volume":"36","author":"XX Yang","year":"2022","unstructured":"Yang XX, Fu SC, Ji R, Li LX, Li YQ, Zuo XL (2022) A novel flexible auxiliary single-arm transluminal endoscopic robot facilitates endoscopic submucosal dissection of gastric lesions (with video). Surg Endosc 36(7):5510\u20135517. https:\/\/doi.org\/10.1007\/S00464-022-09194-X","journal-title":"Surg Endosc"},{"key":"12972_CR11","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.vgie.2024.12.004","volume":"10","author":"SH Kim","year":"2025","unstructured":"Kim SH, Choi HS, Jeon HJ, Kim ES, Keum B, Jeen YT et al (2025) Novel robotic gripper for traction and closure in colorectal endoscopic submucosal dissection. VideoGIE 10:183\u2013186. https:\/\/doi.org\/10.1016\/j.vgie.2024.12.004","journal-title":"VideoGIE"},{"key":"12972_CR12","doi-asserted-by":"publisher","DOI":"10.1136\/GUTJNL-2025-336937","author":"D Szvarca","year":"2025","unstructured":"Szvarca D, Walradt T, Aihara H, Thompson CC (2025) Robot versus conventional ESD for colonic lesions: results from a randomising model trial. Gut. https:\/\/doi.org\/10.1136\/GUTJNL-2025-336937","journal-title":"Gut"},{"issue":"4","key":"12972_CR13","doi-asserted-by":"publisher","first-page":"2280","DOI":"10.1007\/S00464-024-10743-9","volume":"38","author":"SH Kim","year":"2024","unstructured":"Kim SH, Kwon T, Choi HS, Kim C, Won S, Jeon HJ et al (2024) Robot-assisted gastric endoscopic submucosal dissection significantly improves procedure time at challenging dissection locations. Surg Endosc 38(4):2280\u20132287. https:\/\/doi.org\/10.1007\/S00464-024-10743-9","journal-title":"Surg Endosc"},{"key":"12972_CR14","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/JGH.16021","volume":"38","author":"T Omori","year":"2023","unstructured":"Omori T, Funasaka K, Horiguchi N, Kamano T, Nagasaka M, Nakagawa Y et al (2023) Injury to the muscle layer, increasing the risk of post-colorectal endoscopic submucosal dissection electrocoagulation syndrome. J Gastroenterol Hepatol 38:87\u201393. https:\/\/doi.org\/10.1111\/JGH.16021","journal-title":"J Gastroenterol Hepatol"},{"key":"12972_CR15","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/S0166-4115(08)62386-9","volume":"52","author":"SG Hart","year":"1988","unstructured":"Hart SG, Staveland LE (1988) Development of NASA-TLX (Task Load Index): results of empirical and theoretical research. Adv Psychol 52:139\u2013183. https:\/\/doi.org\/10.1016\/S0166-4115(08)62386-9","journal-title":"Adv Psychol"},{"key":"12972_CR16","doi-asserted-by":"publisher","unstructured":"Hart SG (2006) NASA-task load index (NASA-TLX); 20 years later. Proceedings of the Human Factors and Ergonomics Society 50(9).  https:\/\/doi.org\/10.1177\/154193120605000909","DOI":"10.1177\/154193120605000909"},{"issue":"3","key":"12972_CR17","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/S00595-012-0313-7","volume":"43","author":"H Niitsu","year":"2012","unstructured":"Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y et al (2012) Using the objective structured assessment of technical skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 43(3):271\u2013275. https:\/\/doi.org\/10.1007\/S00595-012-0313-7","journal-title":"Surg Today"},{"issue":"11","key":"12972_CR18","doi-asserted-by":"publisher","first-page":"3261","DOI":"10.1007\/S00464-015-4070-8","volume":"29","author":"MA Aghazadeh","year":"2015","unstructured":"Aghazadeh MA, Jayaratna IS, Hung AJ, Pan MM, Desai MM, Gill IS et al (2015) External validation of global evaluative assessment of robotic skills (GEARS). Surg Endosc 29(11):3261\u20133266. https:\/\/doi.org\/10.1007\/S00464-015-4070-8","journal-title":"Surg Endosc"},{"key":"12972_CR19","doi-asserted-by":"publisher","DOI":"10.1016\/J.GIE.2025.09.012","author":"HJ Jeon","year":"2025","unstructured":"Jeon HJ, Keum B, Lee B, Kim S, Choi HS, Lee JM et al (2025) A novel robotic arm\u2013assisted endoscopic submucosal dissection platform with augmented traction for gastric neoplasms: a first-in-human prospective pilot study (with videos). Gastrointest Endosc. https:\/\/doi.org\/10.1016\/J.GIE.2025.09.012","journal-title":"Gastrointest Endosc"},{"key":"12972_CR20","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/7047481","volume":"2022","author":"H Du","year":"2022","unstructured":"Du H, Liu X, Sun H, Zhu Q, Sun L (2022) Progress in control-actuation robotic system for gastrointestinal NOTES development. BioMed Res Int 2022:7047481. https:\/\/doi.org\/10.1155\/2022\/7047481","journal-title":"BioMed Res Int"},{"key":"12972_CR21","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1055\/A-2411-0892","volume":"57","author":"PWY Chiu","year":"2024","unstructured":"Chiu PWY, Yip HC, Chu S, Chan SM, Lau HSL, Tang RSY et al (2024) Prospective single-arm trial on feasibility and safety of an endoscopic robotic system for colonic endoscopic submucosal dissection. Endoscopy 57:240. https:\/\/doi.org\/10.1055\/A-2411-0892","journal-title":"Endoscopy"},{"key":"12972_CR22","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1080\/17474124.2017.1356225","volume":"11","author":"DE Yung","year":"2017","unstructured":"Yung DE, Banfi T, Ciuti G, Arezzo A, Dario P, Koulaouzidis A (2017) Musculoskeletal injuries in gastrointestinal endoscopists: a systematic review. Expert Rev Gastroenterol Hepatol 11:939\u2013947. https:\/\/doi.org\/10.1080\/17474124.2017.1356225","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"12972_CR23","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1055\/S-0042-106722","volume":"48","author":"A Bhatt","year":"2016","unstructured":"Bhatt A, Abe S, Kumaravel A, Parsi MA, Stevens T, Jang S et al (2016) Video-based supervision for training of endoscopic submucosal dissection. Endoscopy 48:711\u2013716. https:\/\/doi.org\/10.1055\/S-0042-106722","journal-title":"Endoscopy"},{"key":"12972_CR24","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1016\/j.gie.2021.01.026","volume":"93","author":"H Aihara","year":"2021","unstructured":"Aihara H, Dacha S, Anand GS, Byrne KR, Chahal P, James T et al (2021) Core curriculum for endoscopic submucosal dissection (ESD). Gastrointest Endosc 93:1215\u20131221. https:\/\/doi.org\/10.1016\/j.gie.2021.01.026","journal-title":"Gastrointest Endosc"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12972-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-026-12972-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-12972-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T21:11:30Z","timestamp":1786396290000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-026-12972-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":24,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["12972"],"URL":"https:\/\/doi.org\/10.1007\/s00464-026-12972-6","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"2 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Drs. Lee, Park, Firkins, Satoi, FNU, Cho, and Bhatt do not have any financial conflicts of interest or disclosures relevant to this study or the product. The robotic system used in this study was provided by Agilis Robotics and its subsidiaries Agilis Robotics Limited and Agilis Robotics Limited (Guangzhou).","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}