Standard polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are established techniques for the treatment of gastrointestinal tumors. However, resection of submucosal tumors via ESD often results in low rates of microscopically margin-negative (R0) resection and high rates of perforation. Endoscopic full thickness resection (EFTR) overcomes this adverse event and aids in the therapeutic management of complex tumors.
Multiple techniques for EFTR have been developed, each with its own advantages and disadvantages. Submucosal tunneling and nonexposed techniques are generally preferable, because the layer of overlying intact mucosa reduces the incidence of intraperitoneal contamination by the gastric fluid and dissemination of the tumor cells. However, adoption of EFTR by endoscopists in clinical practice remains low. The major challenge seems to be the technical difficulty in performing laparoscopic and/or endoscopic suturing using the currently available instruments.
We developed a novel robotic endoscopic platform with suturing capabilities to overcome the technical challenges of suturing. This platform allows easy maneuvering and triangulation of the instruments, thus facilitating endoscopic suturing using robotic arms. Our studies have demonstrated that this robotic endoscopic platform with suturing capabilities is an effective and safe method for performing EFTR with endoscopic suturing.

Therapeutic endoscopic resection has gained favor for its ability to achieve high en bloc and histologically complete resection rates via a minimally invasive approach. The main technical difficulties faced by interventionists are first the lack of traction causing suboptimal visualization of the dissection field and second, the lack of triangulation using existing therapeutic apparatuses. These challenges can be overcome with the use of robots and the multiple degrees of freedom afforded by the robotic wrists. Nevertheless, complications such as bleeding and perforation can occur. It is hence beneficial for the robotic device to be equipped with additional abilities such as suturing. Once the robotic prototypes have been fully optimized and marketed, a structured program should be instituted to ensure proper and adequate training of the end-users. The future of robotics should then explore the possibility of developing a soft robot or a robot with more natural human-like movements. A robot with a force feedback mechanism would be superior and improve safety. Eventually, a supervised autonomous robot may perform interventions with greater precision and accuracy than an expert procedurist. This review describes the benefits of robot-assisted endoscopic resections, recent developments aimed at managing iatrogenic complications and future directions for robotic endoscopy.