title: A pilot ex vivo evaluation of a telerobotic system for transurethral intervention and surveillance.
abstract: BACKGROUND
  Transurethral resection of bladder tumor (TURBT) and pathological staging are both standard surgical therapies for nonmuscle-invasive bladder cancer and integral parts of the diagnostic evaluation and progression monitoring of all bladder tumors. We developed and tested a dexterous robot that can fit through a standard resectoscope for evaluation for possible en bloc resection of bladder tumors, especially tumors along the dome and anterior wall of the bladder.
  
  
  METHODS
  Our dexterous robot uses a continuum (snake-like) mechanical architecture with three working channels through which a fiberscope, biopsy graspers, and a holmium laser were placed. The continuum robot has two segments. Using indigo carmine, injections were performed through the detrusor muscle into the mucosa of the ex vivo bovine bladders at a total of 11 positions throughout all quadrants of the bladder. The snake robot was used in conjunction with the holmium laser to ablate nine of the lesions; two additional lesions were resected en bloc using the grasper and the laser down through the muscle layer.
  
  
  RESULTS
  Both experiments showed that the robotic system was able to directly visualize all 11 targets. In both the bladders, we were able to resect en bloc two tumors using the grasper and 200 μm holmium laser fiber down to the muscle layer indicating a good resection. All of the other targets were completely ablated using the holmium laser.
  
  
  CONCLUSIONS
  The dexterous robot allowed for visualization as well as provided adequate ablation and en bloc resection of bladder lesions throughout the entire bladder.
authors.affiliation: 1 Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: Pickens
authors.forename: Andrea
authors.initials: A
authors.lastname: Bajo
authors.forename: Nabil
authors.initials: N
authors.lastname: Simaan
authors.forename: Duke
authors.initials: D
authors.lastname: Herrell
mesh_terms: D000818:Animals; D002417:Cattle; D015653:Cystectomy / Q000295:instrumentation* / Q000379:methods; D004195:Disease Models, Animal; D018450:Disease Progression; D006801:Humans; D009367:Neoplasm Staging; D065287:Robotic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D014521:Urethra; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
references.citation: Diagn Pathol. 2012 Aug 13;7:98
references.pmid: 22889003
references.citation: BJU Int. 2007 Oct;100(4):728-9
references.pmid: 17419694
references.citation: Semin Surg Oncol. 1989;5(1):30-7
references.pmid: 2652246
references.citation: J Urol. 2000 Mar;163(3):878-9
references.pmid: 10687997
references.citation: IEEE Trans Biomed Eng. 2013 Apr;60(4):918-25
references.pmid: 23144027
references.citation: World J Urol. 2011 Aug;29(4):433-42
references.pmid: 21544662