Endoscopic submucosal dissection (ESD) poses considerable technical challenges and is frequently associated with lengthy procedure times. To improve procedural efficiency, we developed a robotic gripper capable of performing both tissue traction and defect closure. After demonstrating its utility in preclinical experiments, we carried out the first-in-human clinical trial to evaluate its feasibility and safety in colorectal ESD.

From April through June 2025, we performed colorectal ESD with the robotic gripper in 23 consecutive patients at our institution. The primary outcomes assessed were total procedure time, dissection speed, and successful completion of defect closure. Secondary outcomes included the clip count needed for closure and any complications occurring after the procedure.

23 patients with colorectal lesions (mean size, 43.6 ± 4.3 mm) underwent ESD using the robotic gripper. The mean procedure time was 42.8 ± 4.3 minutes, and the average dissection speed was 69.4 ± 18.1 mm²/min. Complete closure of the mucosal defect was achieved in all cases, requiring a mean of 6.3 ± 2.8 clips per lesion. No delayed bleeding or perforation was observed.

This first-in-human evaluation of a robotic dual-function gripper for colorectal ESD showed the device to be feasible, safe, and effective, with clear benefits in traction and closure. These promising results warrant further assessment in larger, multicenter trials.