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FROM BENIGN TO MALIGNANT: EFFICACY AND SAFETY OF ENDOROBOTIC SUBMUCOSAL DISSECTION AND LONG-TERM OUTCOMES
Metincan Erkaya
*, Salih N. Karahan, Kamil Erozkan, Ali Alipouriani, Joshua Sommovilla, Scott Steele, Emre Gorgun
Cleveland Clinic, Cleveland, OH
Background:
Endorobotic submucosal dissection (ERSD) using the Da Vinci Single Port platform enables 3D visualization and precise dissection for the distal colorectal lesions. This study aims to evaluate the long-term outcomes, broader applicability, and efficacy of ERSD in a larger patient cohort over an extended follow-up period.
Methods:
We conducted a retrospective analysis of 67 patients who underwent ERSD using the Da Vinci SP platform between 2020 and 2024. Patient demographics, lesion characteristics, procedural details, pathological findings, and long-term outcomes were systematically analyzed. The primary objectives of this study were to evaluate recurrence rates, long-term complications, and oncological outcomes associated with the ERSD procedure.
Results:
The study included 67 patients who underwent ERSD. The median age of the patients was 59 years (IQR: 18), with 59.7% (n=40) being male. The mean body mass index was 28.6 ± 6.1 kg/m
2. The median distance of lesions from the anal verge was 9 cm (IQR: 6.1-11.4 cm). The median operative time was 76 minutes (IQR: 55.5-98). Regarding defect closure, 29 cases had no closure, 23 had suture closure, and 14 had clip suture closure. The mean estimated blood loss was 8.8 ± 14.2 ml. The median specimen size was 38 mm (range: 13-100 mm), with a mean greatest dimension of 4.5 ± 2.9 cm. En-bloc resection was achieved in 91.0% (n=61) of cases. The median length of hospital stay was 0 days (IQR: 0-0), demonstrating that all patients were discharged on the same day. Final pathology results revealed tubulovillous adenomas (TVA) as the most common finding (n=33), followed by adenocarcinoma (n=16), tubular adenomas (TA) (n=10), sessile serrated adenomas (SSA) (n=3), villous adenoma (VA) (n=1), colonic mucosa with fibrosis (n=1), neuroendocrine tumor (n=1), and hyperplastic polyps (n=2). During follow-up, benign regrowth was observed in 3 cases, with no malignant recurrences.
Conclusion:
This long-term study demonstrates that ERSD is not only safe and feasible but also provides durable results with low recurrence rates and minimal long-term complications in distal colorectal lesions. These findings support the broader application of ERSD as a viable alternative to traditional surgical and flexible endoscopic approaches for selected colorectal lesions.
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