Robotic-assisted endoscopic submucosal dissection: a scoping review of preclinical and early clinical evidence

BACKGROUND: Endoscopic submucosal dissection (ESD) is technically demanding and associated with a steep learning curve and increased complication risk. Constraints of conventional endoscopes, together with the observed benefits of robotic assistance in selected surgical procedures, have driven development of robotic systems for advanced endoscopic applications. This review maps the landscape of robotic endoscopic systems in the context of ESD. METHODS: A PRISMA-ScR-compliant scoping review was conducted. Six databases were searched in 2025. Studies evaluating robotic endoscopic platforms for ESD in preclinical or clinical settings were included. Two reviewers independently screened studies. Data were extracted on study characteristics, platform features, experimental design, and outcomes. Findings were synthesised descriptively. RESULTS: Twenty-seven studies were published between 2010 and 2025, with most from 2019 onwards (22; 82%), and mainly from East Asia (23; 85%). Most studies were preclinical (21; 78%), corresponding to mid-level technological readiness (TRL 4-7). Six studies (22%) reported early clinical evaluation (TRL 8), including one multicentre randomised trial. The most frequently studied site was the stomach (18; 67%). Over half of the studies were comparative (15; 56%), including 14 comparing robotic-assisted ESD (R-ESD) with conventional ESD (C-ESD). In preclinical comparisons (n = 13), R-ESD was associated with shorter submucosal dissection times and higher dissection speeds. En bloc resection rates were high overall, with lower rates observed mainly in novice-performed C-ESD. Perforation was uncommon overall, with higher rates concentrated in novice-performed C-ESD. Early clinical studies (IDEAL 1-3) demonstrated high en bloc resection rates with acceptable safety. CONCLUSION: Preclinical comparative evidence suggests improved procedural efficiency with robotic assistance, particularly in novice-operated settings. Early clinical evidence indicates feasibility and acceptable safety. However, findings should be interpreted as exploratory signals rather than established clinical superiority. Further technological refinement and robust clinical evaluation are required before wider adoption.