EndoQuest completes world's first fully robotic transoral gastric procedures

EndoQuest Robotics said on Nov. 5, 2026, that surgeons completed two fully robotic transoral gastric reconstruction procedures with its Endoluminal Surgical System at The Panama Clinic — the first such cases worldwide and the platform's first clinical use in the upper GI tract.

Endoscopy can reach the stomach without a scar, but flexible tools still fight the physics of two-handed surgery. EndoQuest is trying to import robotic triangulation into that tube — starting with post-bypass revisions that usually force a harder choice. Two Panama cases are a milestone, not a market; the real test is whether full-thickness robotic sutures hold up better than today's TORe lottery.

EndoQuest Robotics said surgeons completed two fully robotic transoral gastric reconstruction procedures with its Endoluminal Surgical System, the ELS System, at The Panama Clinic in Panama City. Transoral means the tools went in through the mouth. Gastric means the work was on the stomach. The company calls it a dual milestone: the first fully robotic transoral gastric procedures in the world, and the first clinical use of the ELS System in the upper gastrointestinal tract. The upper GI tract is the esophagus and the stomach. The announcement is dated Nov. 5, 2026. Those lines are EndoQuest's.

The cases build on transoral outlet reduction, TORe. TORe is an endoscopic revision for people who had a Roux-en-Y gastric bypass and later developed a dilated gastrojejunal anastomosis, with recurrent weight gain or dumping that has not responded to other care. That anastomosis is the surgical join between the small stomach pouch and the small intestine. When it stretches, food can pass too easily, and dumping is food leaving the pouch too fast. The robotic version uses two-handed instruments for full-thickness suturing, stitches through the whole wall of the tissue, entirely through the mouth. There is no incision on the skin. Those lines are the company's.

The lead was Dr. Todd Wilson, EndoQuest's chief medical officer and a professor of surgery at McGovern Medical School at UTHealth Houston. The local principal investigator was Dr. Richard Altieri Pérez. Wilson's account of who was there also names Drs. Fred Moll and Santiago Horgan, and Drs. Mohamed Othman and Michel Kahaleh. Those names are in the announcement.

EndoQuest says the ELS System gives a surgeon two-handed robotic controls, dynamic countertraction, triangulation, and a stable operating field. Countertraction is a pull that holds tissue so the other hand can sew. Triangulation is the geometry that lets two tools and a camera meet at the work, instead of everything sliding in on one straight line. The company says that field is for getting at deeper tissue and for bringing muscle to muscle. A surgeon controls the instruments. The announcement does not describe the system choosing or performing the operation on its own. Those lines are EndoQuest's.

The company is also developing transluminal gastric plication under the NOTES heading. NOTES is natural-orifice transluminal endoscopic surgery: reaching the work through a natural opening rather than a cut in the skin. In preclinical work at Brigham and Women's Hospital, EndoQuest says that approach averaged a 70% reduction in stomach volume. Preclinical means the work was not in these Panama patients. In July the company finished enrolling patients in the PARADIGM trial, a study of robotic endoscopic submucosal dissection for lesions in the rectum and sigmoid colon. That is the lower-GI program, separate from these stomach cases. Those lines are the company's.

Eduardo Fonseca is chief executive. Dr. Fred Moll, a co-founder of Intuitive Surgical and of Auris Health, is board chair. The Nov. 5 announcement does not say the FDA has cleared the ELS System, and it does not say the system is for sale in the United States. It does not report how the two patients did, whether there were complications, or how long either procedure took. Those limits are what the announcement leaves out.

The picture is the operating room at The Panama Clinic: chief executive Eduardo Fonseca with the surgical team in green scrubs, holding a banner for the world's first fully robotic transoral gastric surgery. The credit is EndoQuest Robotics.

In plain terms, surgeons in Panama used a flexible robot, controlled by hand, to sew two post-bypass stomach repairs through the mouth. EndoQuest calls that a world first for this kind of case, and the first time this system has been used clinically in the upper GI tract. Two cases are a milestone. They are not an FDA clearance, and they are not a scoreboard of how the patients fared.