scholarly journals An advanced endoscopic surgery robotic platform for removal of early-stage gastrointestinal cancer using endoscopic submucosal dissection

2021 ◽  
Vol 28 (4) ◽  
pp. 186-198
Author(s):  
Ka Chun Lau ◽  
Yeung Yam ◽  
Philip Wai Yan Chiu
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Surgery ◽  
Early Stage ◽  
Experimental Results ◽  
High Rate ◽  
Robotic Platform ◽  
En Bloc ◽  
Technical Problems ◽  
Submucosal Dissection ◽  
Gi Cancer

Two gastrointestinal (GI) cancers, stomach and colorectal cancer, have the fifth and third highest incident rates and the fourth and second highest mortality rates among all cancers, respectively. Combined, they had 2.8 million new cases and 1.6 million deaths annually. Fortunately, early-stage GI cancer has a high five-year survival rate if the tumour can be removed completely. Endoscopic Submucosal Dissection (ESD) is the gold standard for the removal of early-stage GI cancer as it has a high rate of en-bloc resection and a low rate of recurrence. However, ESD is a very technically challenging surgical operation. It has a relatively high rate of failure, including perforation of the stomach or colon. Therefore, a surgical robotic platform with high dexterity and better ergonomics is in high demand, which can ease the technical problems induced by conventional ESD procedures. In our previous study, a prototype of an endoscopic surgery robotic platform was built and the preliminary experimental results showed that the dual flexible arm robotic platform with wire-driven continuum structure was capable of increasing the efficiency and safety in performing ESD under the master-slave controlling scheme. An advanced robotic platform was built based on this prototype to achieve higher flexibility and production requirements. The design of these two platforms and experimental results will be presented in detail.

scholarly journals Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors

2020 ◽  
Vol 21 (12) ◽  
Author(s):  
Kazuya Akahoshi ◽  
Masaru Kubokawa ◽  
Kazuki Inamura ◽  
Kazuaki Akahoshi ◽  
Yuki Shiratsuchi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Epithelial Tumors

Opinion statement With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.

scholarly journals Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

2018 ◽  
Vol 06 (11) ◽  
pp. E1340-E1348 ◽  
Author(s):  
Carl-Fredrik Rönnow ◽  
Noriya Uedo ◽  
Ervin Toth ◽  
Henrik Thorlacius
Keyword(s):  
Learning Curve ◽  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasia ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Immediate Bleeding

Abstract Background and study aims Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. This study evaluated implementation of ESD in the treatment of colorectal neoplasia in a Western center. Patients and methods Three hundred and one cases of colorectal ESD (173 rectal and 128 colonic lesions) were retrospectively evaluated in terms of outcome, learning curve and complications. Results Median size was 4 cm (range 1 – 12.5). En bloc resection was achieved in 241 cases amounting to an en bloc resection rate of 80 %. R0 resection was accomplished in 207 cases (69 %), RX and R1 were attained in 83 (27 %) and 11 (4 %) cases, respectively. Median time was 98 min (range 10 – 588) and median proficiency was 7.2 cm2/h. Complications occurred in 24 patients (8 %) divided into 12 immediate perforations, five delayed perforations, one immediate bleeding and six delayed bleedings. Six patients (2 %), all with proximal lesions, had emergency surgery. Two hundred and four patients were followed up endoscopically and median follow-up time was 13 months (range 3 – 53) revealing seven recurrences (3 %). En bloc rate improved gradually from 60 % during the first period to 98 % during the last period. ESD proficiency significantly improved between the first study period (3.6 cm2/h) and the last study period (10.8 cm2/h). Conclusions This study represents the largest material on colorectal ESD in the west and shows that colorectal ESD can be implemented in clinical routine in western countries after appropriate training and achieve a high rate of en bloc and R0 resection with a concomitant low incidence of complications. ESD of proximal colonic lesions should be attempted with caution during the learning curve because of higher risk of complications.

scholarly journals Endoscopic Submucosal Dissection of Papillary Gastric Adenocarcinoma; Systematic Review

2020 ◽  
Vol 9 (5) ◽  
pp. 1465
Author(s):  
Chang Seok Bang ◽  
Jae Jun Lee ◽  
Gwang Ho Baik
Keyword(s):  
Systematic Review ◽  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
Submucosal Invasion ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection

This study evaluated the possibility of endoscopic submucosal dissection (ESD) for early gastric cancer with papillary adenocarcinoma (EGC-PAC). PAC, an uncommon pathologic type of stomach cancer, is classified into differentiated-type histology. However, aggressive features, including a high rate of submucosal invasion, lymphovascular invasion (LVI), and lymph node metastasis (LNM), have been reported in studies with surgical specimens. Treatment outcomes of ESD for EGC-PAC have not been precisely demonstrated. Core databases were sought for the following inclusion criteria: studies of endoscopic resection or surgery of EGC-PAC presenting the following therapeutic indicators; en bloc resection, complete resection, curative resection, recurrence, complications associated with procedures, LVI, or LNM that enabled an analysis of ESD possibility. Overall, 15 studies were included for systematic review. Frequent submucosal invasion and high LVI were noted in EGC-PAC. However, PAC was not significantly associated with LNM. Pooled en bloc resection, complete resection, and curative resection rates were 89.7% (95% confidence interval: 55.3%–98.4%), 85.3% (67.7%–94.2%), and 67% (43%–84.5%), respectively. No LNM was observed if EGC-PAC satisfied the curative resection criteria. ESD seems technically feasible, although a high LVI rate results in a lower rate of curative resection.

Endoscopic Submucosal Dissection for Early-Stage Neuroendocrine Carcinoma of The Esophagus ：A Case Report

2021 ◽  
Author(s):  
Nan Tang ◽  
Zhonghua Cheng ◽  
Zhen Fen
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Neuroendocrine Carcinoma ◽  
Histopathological Examination ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Muscularis Mucosa ◽  
En Bloc ◽  
Carcinoma Of The Esophagus ◽  
Submucosal Dissection

Abstract Background: Neuroendocrine carcinoma (NEC) of the esophagus is rare, highly aggressive and lacks biological features. Case presentation: In this report, we describe a patient with Esophageal NEC who was successfully treated using endoscopic submucosal dissection (ESD). A 55-year-old woman presented with intermittent mild dysphagia for 2 months. Gastroscopy revealed a disc-shaped protruding lesion about 18mm×18mm in size on the upper esophagus, 25cm from the incisors. Endoscopic ultrasonography (EUS) demonstrated the bulged lesion was highly echoic and homogeneous, originating from the muscularis mucosa. We assessed en bloc resection by ESD for therapeutic diagnosis to be a safe and appropriate treatment. The tumor was removed using ESD. Histopathological examination revealed a poorly differentiated neoplasm comprising large cells with marked nuclear atypia and multifocal necrosis Immunohistochemistry staining revealed tumor tissue that was positive for Ki67, CgA, Syn, CD56, but negative for P40, P63, S-100 protein. These histopathological results were consistent with a diagnosis of esophageal NEC, large cell type, derived from the muscularis mucosae. After comprehensive consideration, we adopted the combination treatments (ESD plus an adjuvant chemotherapy). The patient has been followed up till now with no recurrence. Conclusions: En bloc resection approach by ESD play a vital role in the early therapeutic diagnosis of esophageal NEC.

scholarly journals A Novel Opportunity in Minimally Invasive Colorectal Cancer Therapy: Defining a Role for Endoscopic Submucosal Dissection in the United States

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Jonah Cohen
Keyword(s):  
Colorectal Cancer ◽  
United States ◽  
Minimally Invasive ◽  
Endoscopic Submucosal Dissection ◽  
Early Stage ◽  
The United States ◽  
Histological Evaluation ◽  
Gastrointestinal Neoplasms ◽  
En Bloc ◽  
Submucosal Dissection

Colorectal cancer is the third most common cancer among both men and women in the United States and the second leading cause of cancer death. Endoscopic submucosal dissection (ESD) is an innovative advanced endoscopic therapy for superficial gastrointestinal neoplasms which is rapidly becoming standard of care particularly in Asia. ESD was first developed for the resection of early gastric cancers; yet ESD for colon tumors has gained increasing attention in recent years. The advantage of ESD over conventional endoscopic resection lies in its potential to achieve en bloc resection regardless of tumor size, leading to more precise histological evaluation and greater potential for cure. Selecting appropriate patients for this procedure involves identifying colorectal cancers with nul risk of lymph node spread. For colorectal ESD to engraft in the United States, the prevalence of such early stage lesions must be defined so that centers of excellence can be developed for high volume clinical practice to offer patients the safest and most efficacious outcomes. This review discusses the endoscopic staging of colorectal neoplasms, indications for colorectal ESD, and the epidemiology of early stage ESD-amenable colorectal cancer in America to better define an opportunity for this important minimally invasive therapy.

scholarly journals Prevention and Management of Complications of and Training for Colorectal Endoscopic Submucosal Dissection

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Naohisa Yoshida ◽  
Nobuaki Yagi ◽  
Yutaka Inada ◽  
Munehiro Kugai ◽  
Akio Yanagisawa ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Training System ◽  
High Rate ◽  
Training Methods ◽  
En Bloc ◽  
Efficient Treatment ◽  
Submucosal Dissection ◽  
Management Of Complications ◽  
Model Training ◽  
And Training

Endoscopic submucosal dissection (ESD) is reported to be an efficient treatment with a high rate ofen blocresection for large colorectal tumors in Japan and some other Western and Asian countries. ESD is considered less invasive than laparoscopic colectomy. However, ESD carries a higher risk of perforation than endoscopic mucosal resection (EMR). Various devices and training methods for colorectal ESD have been developed to solve the difficulties. In this review, we describe the complications of colorectal ESD and prevention of those complications. On the other hand, colorectal ESD is difficult for less-experienced endoscopists. The unique step-by-step ESD training system is performed in Japan. Additionally, appropriate training, including animal model training, for colorectal ESD should be acquired before working on clinical cases.

En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video)

2008 ◽  
Vol 67 (2) ◽  
pp. 332-337 ◽  
Author(s):  
Mainor R. Antillon ◽  
Christopher R. Bartalos ◽  
Marc L. Miller ◽  
Alberto A. Diaz-Arias ◽  
Jamal A. Ibdah ◽  
...  
Keyword(s):  
Anal Canal ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Surgery ◽  
En Bloc ◽  
Submucosal Dissection

scholarly journals Feasibility of Endoscopic Submucosal Dissection: A New Technique for En Bloc Resection of a Large Superficial Tumor in the Colon and Rectum

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
T. Shono ◽  
K. Ishikawa ◽  
Y. Ochiai ◽  
M. Nakao ◽  
O. Togawa ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colon And Rectum ◽  
A New Technique ◽  
Average Procedure Time

Endoscopic submucosal dissection (ESD) is a promising procedure that enables en bloc resection of large superficial tumors in the upper gastrointestinal tract. On the other hand, ESD in the colon and rectum is technically difficult to perform because of its anatomical features. At our institution, 137 consecutive superficial colorectal tumors larger than 20 mm in diameter in 137 patients were treated by ESD between April 2007 and October 2010, and 132 lesions were successfully resected. The average procedure time was 79.2 minutes, and the rate of en bloc resection was 89.1% (122/137). The rate of complete resection, defined as en bloc resection with tumor-free lateral and vertical margins, was 85.4% (117/137). The rate of perforation was 3.6% (5/137). Colorectal ESD achieved a high rate of en bloc resection and complete resection and is applicable in the colorectum.

scholarly journals The first case of endoscopic submucosal dissection of cecal adenoma in Serbia

2009 ◽  
Vol 62 (1-2) ◽  
pp. 27-30 ◽  
Author(s):  
Dejan Ivanov ◽  
Takaski Toyonaga
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Screening Program ◽  
Histopathological Examination ◽  
Early Stage ◽  
Ileocecal Valve ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Elevated Type ◽  
First Case

Endoscopic submucosal dissection is a therapeutic procedure for the removal of early stage gastrointestinal cancer. In 2006, we performed a colonic ESD in Serbia. ESD had never been performed until then in Serbia, nor do we have a written report, so this article is a document of the first performed procedure of this kind. On the 21st of October 2006, the patient was admitted to the General Hospital MC in Novi Sad for the performance of ESD of the cecal lesion. A flat-elevated type of lesion on the upper lip of ileocecal valve with a size of 8 mm was found on the colonoscopy. The adenoma was removed en bloc and prepared for further histopathological examination. Histopathological examination showed that the tumor was a 'flat adenoma' of the colon mucosa with a low grade dysplasia. The procedure lasted for 30 minutes and went without complications. The first case of ESD in Serbia was performed in 2006, only four years after it was developed in Japan. To have more ESD cases in our country a screening program for detection of early cancers is needed as well as education of endoscopists in performing ESD.

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