Transurethral Surgical Robot: Achieving Efficient En Bloc Resection of Bladder Tumor

Bladder cancer ranks as the 10th most common cancer globally. Currently, the standard surgical approach for bladder tumor removal involves transurethral piecemeal resection, which carries high recurrence (60%) and perforation (12%) rates. Although various techniques and robotic systems have been developed for en bloc tumor resection, achieving a negative resection margin remains challenging with standard resectoscopes. Here, we present the Robot-Optimized Bladder Endoscopy Resection of Tumor (ROBERT) system, a dual-arm robotic system designed to fit into a standard irrigation sheath along with an endoscope. The ROBERT system offers enhanced dexterity and payload capacity, allowing surgeons to perform en bloc tumor resections effectively. In both ex vivo and in vivo experiments, the ROBERT system achieves negative margins, with muscular tissue visually identified in the excised samples. The fastest resection is completed in approximately 6 min, and the largest excised tissue size is 15 × 15 × 3 mm. These results demonstrate the ROBERT system's feasibility and potential for improving bladder tumor resection outcomes.