Post written by Sang Hyun Kim, MD, PhD, and Hyuk Soon Choi, MD, PhD, from the Division of Gastroenterology and Hepatology, Korea University College of Medicine, Seoul, South Korea.

We describe application of a novel dual-function robotic gripper (ROBOPERA-TraCloser [Dual Gripper]; ENDOROBOTICS, Seoul, South Korea) in colorectal endoscopic submucosal dissection (ESD). This device integrates traction and closure functionalities, enhancing procedural efficiency and safety.

In the first case, a 50-year-old woman presented with a large granular laterally spreading tumor in the sigmoid colon. This lesion measured more than 7 cm in size, and conventional traction methods such as a spring-and-loop with clip (S-O Clip; Zeon Medical, Tokyo, Japan) or a clip with line often fail to provide sufficient traction. In such cases, multiple traction devices may be required, increasing procedural complexity.

To overcome this limitation, we used a dual-function robotic gripper capable of providing dynamic traction, allowing for improved exposure of the submucosal dissection plane and enhanced procedural efficiency. The device’s regrasping capability enabled dynamic traction adjustments throughout the procedure.

The second case involved a 51-year-old man with a suspected neuroendocrine tumor in the mid rectum. This case particularly highlighted the benefits of the dual-function robotic gripper. The patient was on anticoagulant therapy and required defect closure after ESD.

Typically, in such cases, a separate closure device needs to be introduced post ESD, or through-the-scope clip application using conventional methods can be technically challenging. However, with the dual-function robotic gripper, defect closure was seamlessly performed using the same device immediately after completing ESD, simplifying the procedure and enhancing efficiency.

The key point we wanted to emphasize is that the novel dual-function robotic gripper can overcome the limitations of conventional traction devices, particularly when managing large lesions where achieving sufficient traction has been challenging. By providing real-time dynamic traction, this device enhances submucosal exposure and procedural control, significantly improving ESD performance.

In addition, for lesions requiring traction and closure, the ability to seamlessly transition between these functions optimizes procedural efficiency, reducing the need for additional device exchanges and streamlining the overall workflow.

Expanding its application to third-space endoscopy and various other endoscopic procedures could further validate its clinical use and establish its role in improving endoscopic techniques.

Summary of the second case. A, A 1-cm, yellow-colored subepithelial tumor in the mid rectum. B, The robotic gripper was used to lift the flap, allowing full visualization of the yellow nodule within the submucosal space. C, ESD defect after completion of dissection. D, The robotic gripper was used to approximate ESD defect. E, Complete closure of ESD defect using TTS clips. ESD, Endoscopic submucosal dissection; TTS, through-the-scope.

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