Endoscopic submucosal dissection (ESD) is an effective but technically challenging treatment for esophageal neoplasms, with significant complication risks. To address these limitations, various tissue traction techniques have been developed. This study evaluates the feasibility and efficacy of a novel retractable robotic traction device designed to facilitate tissue traction during esophageal ESD. 

Three endoscopists performed ESD procedures on live porcine esophagus using both the robotic device and the conventional technique. Artificial lesions involving 50% and 30% of the esophageal circumference were created in both the mid and lower esophagus and assigned to either group. Primary outcomes included procedure time, dissection speed, incidence of procedure-related adverse events, and blind dissection rate. 

We performed 12 robotic ESDs (RESD) and 12 conventional ESDs (CESD) across six pigs. RESD showed a significantly shorter total procedure time (30.1 ± 13.1 minutes) compared to CESD (42.3 ± 17.4 minutes, p < 0.05). RESD also achieved a significantly higher submucosal dissection speed (48.3 ± 7.8 mm²/min versus 20.2 ± 7.4 mm²/min, p < 0.05), along with a lower rate of blind dissection (8.5% ± 2.7% versus 24.2% ± 11.1%, p < 0.05) and muscle damage (3.0 ± 1.4 versus 5.9 ± 3.2%, p < 0.05). The advantage of RESD over CESD was more pronounced in lesions involving 50% of the esophageal circumference than in those involving 30%. 

The robotic gripper facilitated efficient ESD by providing controlled, multidirectional traction. These findings suggest the device may enhance procedural performance and overcome technical challenges of ESD, particularly in large esophageal lesions.