A Master–Slave Controlled Flexible Robotic System for Endoscopic Submucosal Dissection: Integrated Endoscope Guidance and Dual‐Arm Manipulation (With Video)

BACKGROUND: Endoscopic submucosal dissection (ESD) is limited by unstable visualization, insufficient traction, and the ergonomic burden of manual endoscope manipulation, particularly in the colorectum. METHODS: We developed EndoDreams, a flexible robotic ESD assistant integrating master-slave control for both dual-arm instrumentation and endoscope guidance (insertion, withdrawal, and rotation). Master-slave responsiveness was quantified in benchtop latency and repeatability tests. In vivo feasibility was evaluated in a porcine, lesion-level randomized study (n = 24; 12 gastric, 12 colorectal), with each lesion resected under robotic assistance using standardized ESD protocols. RESULTS: ), EndoDreams significantly increased dissection efficiency, with shorter dissection time and higher standardized dissection speed, which improved submucosal exposure in both gastric lesions and colorectal lesions. EndoDreams. Safety outcomes suggested a potential benefit for EndoDreams platform, particularly in the colorectal lesions (lower muscular injury and perforation), and in which operator workload (NASA-TLX) was reduced as well. CONCLUSIONS: The EndoDreams system addresses major limitations in conventional ESD by enabling endoscope delivery and precise, dual-arm tissue handling under a master-slave control framework. The combined benchtop and in vivo validations confirm its feasibility and clinical safety.