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

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.