Robot-assisted versus conventional endoscopic submucosal dissection: a systematic review and meta-analysis.

内容摘要

Robot-assisted endoscopic submucosal dissection (RA-ESD) has been developed to address the ergonomic and technical limitations of conventional ESD (C-ESD). However, the current evidence base remains limited and is predominantly derived from preclinical studies. To systematically evaluate the comparative efficacy and safety of RA-ESD versus C-ESD. Systematic review and meta-analysis. A comprehensive literature search was conducted in major electronic databases in accordance with the PRISMA 2020 Statement. Comparative studies assessing RA-ESD versus C-ESD were included. Continuous outcomes were pooled using mean differences (MDs), and dichotomous outcomes were analyzed using odds ratios (ORs), both with 95% confidence intervals (CIs). Random-effects models were applied for all primary analyses. Twelve studies (n = 581) were included, of which the majority were preclinical. In exploratory pooled analyses, RA-ESD was associated with shorter submucosal dissection time (min) (MD -6.62, 95% CI -9.38 to -3.86) and overall procedure time (min) (MD -6.00, 95% CI -9.13 to -2.86). Dissection speed (mm2/min) was higher with RA-ESD (MD 35.80, 95% CI 8.98 to 62.62), although heterogeneity was substantial. The blind dissection rate (%) was lower in the RA-ESD group (MD -22.64, 95% CI -31.49 to -13.78). RA-ESD was associated with a higher en bloc resection rate (OR 6.44, 95% CI 1.05 to 39.39) and a lower risk of muscular injury (OR 0.18, 95% CI 0.06 to 0.53). No significant difference in perforation was observed. RA-ESD demonstrates promising technical advantages over C-ESD, including improved procedural efficiency and reduced technical difficulty, without an apparent increase in major adverse events. However, given that the current evidence is predominantly preclinical and characterized by substantial heterogeneity, these findings should be interpreted as preliminary and hypothesis-generating. Further well-designed clinical studies are required to confirm the real-world effectiveness, safety, and long-term outcomes of RA-ESD. PROSPERO registration number: CRD420261336534. Robot-assisted ESD may make complex early cancer removal faster and easier than standard ESD This study looked at whether robot-assisted endoscopic submucosal dissection (RA-ESD) works better than the standard technique (C-ESD). ESD is a minimally invasive procedure used to remove abnormal or early cancerous tissue from the digestive tract without open surgery. However, standard ESD can be technically difficult and physically demanding for the operator. We reviewed 12 studies involving 581 procedures and combined their results. Overall, robot-assisted ESD was linked to better technical performance. It shortened the time needed to remove tissue, increased the speed of dissection, reduced the amount of “blind” cutting, and improved the chance of removing the lesion in one piece. It was also associated with fewer injuries to the muscle layer. The risk of perforation was similar between the two approaches. These findings suggest that robot-assisted ESD may help doctors perform this difficult procedure more efficiently and with greater control, without reducing safety. This could potentially improve treatment quality for patients. However, the current evidence is still limited. Many of the included studies were performed in preclinical settings, such as animal or laboratory models, or were early-stage clinical studies. This means the results should be interpreted with caution. Larger, well-designed clinical trials in real patients are still needed to confirm whether robot-assisted ESD provides clear long-term benefits in routine medical practice.