.

Endoscopic Submucosal Dissection (ESD) can be used for larger polyps, and also involves lifting the polyp with injected solutes. The benefits of ESD include the complete en bloc removal of the specimen rather than by piece-meal [1-2].

needle-knife-endoscopic-submucosal-dissection_e

Robotic transanal endoscopic submucosal dissection (ESD)

Robotic Transanal Endoscopic Submucosal Dissection (RTESD) was first performed in Australia in 2015 using a Gelpoint TAMIS® port and the da Vinci® SI robot[3]. The da Vinci® robot has certain advantages over previously used techniques for ESD and EMR. This is largely due to the ability of the robot’s small miniaturised robotic hands to perform complex movements including suturing within the very narrow confines of the rectum.  This procedure has been recently described using the daVinci robot [3] for extra fine motor control and precision.

References

  1. Moss A. Bourke MJ. Tran K. Godfrey C. McKay G. Chandra AP. Sharma S. Lesion isolation by circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) substantially improves en bloc resection rates for 40-mm colonic lesions. Endoscopy. 42(5):400-4, 2010 May.
  2. Moss A, Bourke MJ, Metz AJ, McLeod D, Tran K, Godfrey C, McKay G, Chandra AP, Pasupathy A. Beyond the snare: technically accessible large en bloc colonic resection in the West: an animal study. Dig Endosc. 24 (1):21-9, 2012 Jan.
  3. Lajevardi SS, Tameev Z, McKay G. Robotic Transanal Endoscopic Submucosal Dissection (RTESD) of Large Rectal Tumor in Prone Position. J Minim Invasive Surg Sci. 2016 May; In Press(In Press):e34095.