Metincan Erkaya

Background: Endoscopic submucosal dissection (ESD) is technically challenging for complex colorectal lesions, while endorobotic submucosal dissection (ERSD) has emerged as a transanal minimally invasive alternative offering high-definition 3D visualization and improved instrument dexterity. However, evidence-based technique selection criteria remain unclear. This study compares the technical success and operative efficiency between ERSD and ESD using a lesion size-stratified analysis to guide technique selection. Methods: Retrospective analysis of prospectively collected data from consecutive patients who underwent ERSD or ESD for distal colorectal lesions at a tertiary referral center (2020–2024). All procedures were performed by a single expert endoluminal surgeon to eliminate learning curve bias. The Da Vinci SP robot was used for ERSD. The primary outcomes included en bloc resection rates, operative time, and perioperative complications. Lesions were stratified by surface area: small (< 10 cm ² ), medium (10–25 cm ² ), and large (≥ 25 cm ² ). Statistical analysis assessed the relationship between lesion size and operative time for both techniques. Results: A total of 164 patients were analyzed (ERSD: n = 79, ESD: n = 85). ERSD patients had significantly larger lesions (median surface area 18.4 vs 6.3 cm ² , p < 0.001) while maintaining similar overall operative times (75 vs 78 min, p = 0.42). En bloc resection rates were comparable (97.5% vs 96.5%, p = 0.99). Intraoperative perforation occurred in 2.5% of ERSD cases compared to 4.8% of ESD cases ( p = 0.75); all perforations were full-thickness defects successfully managed endoscopically or transanally without additional surgical intervention. Postoperative complications occurred in 10.1% vs 8.2% ( p = 0.88). The majority of complications were Clavien–Dindo Grade I–II, with no Grade IV or V events in either group. Operative time correlated with specimen size for both techniques (ERSD: r = 0.59; ESD: r = 0.46; both p < 0.001). Size-stratified analysis revealed equivalent times for small lesions (71 vs 67 min, p = 0.85) but significant ERSD advantages for medium (65 vs 119 min, p = 0.03) and large lesions (87 vs 142 min, p = 0.04), despite robotic setup overhead. Conclusion: Endorobotic submucosal dissection demonstrated substantial time savings for lesions ≥ 10 cm ² without compromising safety or resection quality, suggesting that lesion size may serve as a useful parameter for technique selection between ERSD and ESD.

Aim: This study compared short‐ and long‐term outcomes of robotic and laparoscopic low anterior resection (LAR) for rectal adenocarcinoma using sex‐stratified analyses. Methods: Patients who underwent elective robotic or laparoscopic LAR for rectal cancer were included. Prospectively maintained database of outcomes was analysed retrospectively. To minimise selection bias, groups were matched. Results: Of 409 identified patients, 380 met the eligibility criteria (mean age: 61 years, BMI: 26.2 kg/m ² ). In a matched cohort of males ( n = 172) and females ( n = 114), robotic surgery was associated with significantly shorter hospital stay ( p < 0.01). Harvested lymph nodes, margins, morbidity and local recurrence were comparable in males ( p > 0.05). Robotic surgery in females was associated with fewer harvested lymph nodes ( p = 0.01). Five‐year disease‐specific survival rates did not significantly differ between approaches in either gender. Conclusions: Robotics and laparoscopic LAR achieved similar oncologic outcomes. The findings should be interpreted as sex‐stratified comparisons rather than evidence of differential effect of surgical approach according to sex.

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Background: Endorobotic submucosal dissection (ERSD) using the da Vinci single-port (SP) platform offers high-definition visualization and enhanced precision for the resection of distal colorectal lesions. In contrast, conventional endoscopic submucosal dissection is technically demanding and associated with a steep learning curve. This study aims to evaluate the efficacy, broader applicability, and long-term outcomes of ERSD in a large patient cohort. Methods: We retrospectively analyzed 101 patients who underwent ERSD using the da Vinci SP platform between March 2020 and May 2025. Patient demographics, lesion characteristics, procedural details, pathological findings, and long-term follow-up data were reviewed. The primary objectives were to assess intraoperative and postoperative complications, evaluate the feasibility of en-bloc submucosal dissection, and examine the oncological outcomes associated with the ERSD procedure. Results: The median age of the cohort was 62.5 years (IQR: 52–70 years), with 56.4% male patients. The median distance from the anal verge was 8 cm (IQR: 6–11 cm, range: 1–24 cm). En-bloc resection was achieved in 96.0% of the cases, with a median procedure time of 73 min (IQR: 53–97). The median length of hospital stay was 0 days. The median specimen size was 19 cm ² (IQR: 11–28), with a median greatest dimension of 5 cm (range: 1–18 cm). Final pathology revealed tubulovillous adenoma in 57.4% of the cases, tubular adenoma in 16.7%, and serrated adenoma in 6.0%, adenocarcinoma in 12.9%, neuroendocrine tumor in 1.0%, villous adenoma in 1.0%, and colonic mucosa/scar in 5.0%. No metastases or malignant recurrences were observed during the median follow-up of 22 months in patients with adenocarcinoma. Across the entire cohort, three non-cancer-related deaths occurred during follow-up. Conclusion: Our experience demonstrates that ERSD is not only safe and feasible but also provides durable results with minimal long-term complications and high rates of en-bloc resection in distal colorectal lesions. These findings support the broader application of ERSD as a viable alternative to the traditional transanal approaches for selected colorectal lesions.

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