A Novel Robotic System Based on Heterogeneous Master-Slave control Algorithm: Design and Its Clinical Application in Endoscopic Submucosal Dissection

A Novel Robotic System Based on Heterogeneous Master-Slave control Algorithm: Design and Its Clinical Application in Endoscopic Submucosal Dissection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Novel Robotic System Based on Heterogeneous Master-Slave control Algorithm: Design and Its Clinical Application in Endoscopic Submucosal Dissection Keshun Fan, Miko Lin Lv, Hongdong Tian, Luping Shen, Ang Ke, long chen, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7200738/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Sep, 2025 Read the published version in Journal of Robotic Surgery → Version 1 posted 11 You are reading this latest preprint version Abstract Background : Endoscopic Submucosal Dissection (ESD) is the gold standard for early gastrointestinal tumor resection but remains technically demanding due to limitations in visualization, traction, and instrument control. A flexible auxiliary single-arm transluminal endoscopic robot (FASTER, EndoFaster) was therefore developed to provide real-time traction assistance. Methods: The EndoFaster system underwent a two-stage validation. Technical assessment confirmed real-time control performance, including motion latency, trajectory fidelity, and positional accuracy. Subsequently, a prospective, randomized multicenter trial across six hospitals enrolled 192 ESD patients, randomized 1:1 to robotic-assisted ESD or conventional ESD. Primary endpoint was en bloc (R0) resection rate; secondary endpoints included dissection time, submucosal visualization, intraprocedural complications, and operator workload. Results: EndoFaster achieved stable, accurate motion performance, exhibiting average startup and following delays of 231 ms and 326 ms, respectively. In clinical trials, en bloc resection rates were comparable between the EndoFaster (98.84%) and control groups (98.13%), confirming non-inferiority. The system significantly reduced dissection time (P = 0.00435), improved submucosal visualization, and decreased muscular injury incidence and operator workload. Conclusions: The EndoFaster robotic assistance system serves as a dynamic "third hand," effectively enhancing submucosal visualization and traction control. This improves the safety and efficiency of ESD while preserving standard clinical workflows. EndoFaster robotic-assisted ESD submucosal visualization real-time traction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Sep, 2025 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 07 Aug, 2025 Reviews received at journal 07 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers agreed at journal 02 Aug, 2025 Reviews received at journal 30 Jul, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers invited by journal 28 Jul, 2025 Editor assigned by journal 25 Jul, 2025 Submission checks completed at journal 24 Jul, 2025 First submitted to journal 23 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7200738","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492081430,"identity":"a883fd62-2e15-4c3b-bb64-64208e633293","order_by":0,"name":"Keshun Fan","email":"","orcid":"","institution":"Robo Medical Technology Co, Ltd","correspondingAuthor":false,"prefix":"","firstName":"Keshun","middleName":"","lastName":"Fan","suffix":""},{"id":492081431,"identity":"918a06d1-4390-4346-a455-6d05f8c1d48e","order_by":1,"name":"Miko Lin Lv","email":"","orcid":"","institution":"Robo Medical Technology Co, 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(A) Mid-esophagus posterior wall (2.1×4.7 mm), (B) Pyloric anterior wall (2.4×2.9 mm), (C) Antral greater curvature (3.4×3.0 mm), (D) Antral anterior wall (1.6×1.5 mm), (E) Angular incisura (5.6×3.2 mm).\u003c/p\u003e","description":"","filename":"fig12.png","url":"https://assets-eu.researchsquare.com/files/rs-7200738/v1/554a7d0f8d9083952fb02614.png"},{"id":91889959,"identity":"d1a9f8e0-9b64-42b1-9d70-970349d7e6ec","added_by":"auto","created_at":"2025-09-22 16:03:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":15713415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscriptANovelRoboticSystemBasedonHeterogeneousMast.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7200738/v1_covered_c2c6dfee-7949-49cb-8334-8f56b848f254.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Novel Robotic System Based on Heterogeneous Master-Slave control Algorithm: Design and Its Clinical Application in Endoscopic Submucosal Dissection","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"EndoFaster, robotic-assisted ESD, submucosal visualization, real-time traction","lastPublishedDoi":"10.21203/rs.3.rs-7200738/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7200738/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground :\u003c/h2\u003e\u003cp\u003eEndoscopic Submucosal Dissection (ESD) is the gold standard for early gastrointestinal tumor resection but remains technically demanding due to limitations in visualization, traction, and instrument control. A flexible auxiliary single-arm transluminal endoscopic robot (FASTER, EndoFaster) was therefore developed to provide real-time traction assistance.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eThe EndoFaster system underwent a two-stage validation. Technical assessment confirmed real-time control performance, including motion latency, trajectory fidelity, and positional accuracy. Subsequently, a prospective, randomized multicenter trial across six hospitals enrolled 192 ESD patients, randomized 1:1 to robotic-assisted ESD or conventional ESD. Primary endpoint was en bloc (R0) resection rate; secondary endpoints included dissection time, submucosal visualization, intraprocedural complications, and operator workload.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eEndoFaster achieved stable, accurate motion performance, exhibiting average startup and following delays of 231 ms and 326 ms, respectively. In clinical trials, en bloc resection rates were comparable between the EndoFaster (98.84%) and control groups (98.13%), confirming non-inferiority. The system significantly reduced dissection time (P\u0026thinsp;=\u0026thinsp;0.00435), improved submucosal visualization, and decreased muscular injury incidence and operator workload.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eThe EndoFaster robotic assistance system serves as a dynamic \"third hand,\" effectively enhancing submucosal visualization and traction control. This improves the safety and efficiency of ESD while preserving standard clinical workflows.\u003c/p\u003e","manuscriptTitle":"A Novel Robotic System Based on Heterogeneous Master-Slave control Algorithm: Design and Its Clinical Application in Endoscopic Submucosal Dissection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 10:21:01","doi":"10.21203/rs.3.rs-7200738/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-08T00:10:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-07T12:53:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247551224362329213342092120806568746072","date":"2025-08-06T21:54:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80475470257085534914750027387785208328","date":"2025-08-04T19:32:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185503817729909498187066100314730183336","date":"2025-08-02T23:04:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T00:43:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1667921281404070177347433885963832362","date":"2025-07-30T07:59:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-28T07:23:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-25T11:28:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-24T13:41:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2025-07-24T02:43:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d5a21c41-a9e9-4bae-b00b-88d0fa9cc94a","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T16:01:43+00:00","versionOfRecord":{"articleIdentity":"rs-7200738","link":"https://doi.org/10.1007/s11701-025-02686-7","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2025-09-19 15:57:46","publishedOnDateReadable":"September 19th, 2025"},"versionCreatedAt":"2025-07-31 10:21:01","video":"","vorDoi":"10.1007/s11701-025-02686-7","vorDoiUrl":"https://doi.org/10.1007/s11701-025-02686-7","workflowStages":[]},"version":"v1","identity":"rs-7200738","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7200738","identity":"rs-7200738","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}