Post written by Carlos E. Bertran-Rodriguez, MD, and Dennis Yang, MD, from the Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, Florida, USA.

Our video demonstrates use of a novel robotic—assisted traction device (TraCloser; EndoRobotics, Seoul, South Korea) during colorectal endoscopic submucosal dissection (ESD) of a rectal 60-mm laterally spreading granular tumor. The robotic gripper arm allowed real-time adjustments for dynamic traction during the procedure, optimizing exposure of the dissection plane and enhancing pre-emptive and active hemostasis.

Upon completion of ESD, the robotic gripper was used to also facilitate approximation of the resection margins for mucosal clip closure. Final histopathology was consistent with en bloc complete (R0) resection of a tubulovillous adenoma with high-grade dysplasia.

ESD remains one of the most technically demanding procedures in therapeutic endoscopy, and effective traction is critical for safe and efficient dissection. To our knowledge, the novel robotic platform introduced in this video was the first clinical case performed in North America demonstrating the clinical use of this traction-assistance device during colorectal ESD.

Our experience suggests that robotic-assisted traction is feasible and can be integrated into colorectal ESD workflows with relative ease. The ability to dynamically modify traction during dissection may help maintain optimal tissue tension, improve visualization of the submucosal plane, and facilitate management of intraprocedural bleeding.

We also recognize that successful use of these platforms has a learning curve and requires precise coordination between the endoscopist and assistant. Larger studies are needed to further corroborate the potential clinical use of this novel device.

Robotic-assisted traction during endoscopic submucosal dissection (ESD). A, Large, bulky 65-mm laterally spreading granular mixed lesion (Paris 0-Is + IIa) in the rectum. B, The distal edge of the mucosal flap was grasped with the robotic gripper to apply traction during dissection. The robotic arm was repositioned during the procedure to provide real-time adjustments to optimize tissue tension and visualization during ongoing submucosal dissection (C) and exposure of bleeding for hemostasis (D). E, The robotic arm was used to assist with apposition of the mucosal edges of the ESD defect for clip closure. F, Final resected specimen measuring 75 × 70 mm in size.

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