# A Robotic System to Remove Bladder Tumors Intact: The Key to Making Lifesaving Treatment Decisions

> **NIH NIH R44** · VIRTUOSO SURGICAL, INC. · 2024 · $908,121

## Abstract

Project Summary/Abstract:
The objective of this proposal is to create a new robotic system that enables bladder tumors to be removed
completely and intact. Currently they are removed piecemeal, which spreads cancer cells, and results in incon-
clusive diagnosis and staging, which dramatically increases morbidity and mortality for patients. Our system will
deliver two needle-sized, tentacle-like arms through the port of a standard transurethral endoscope, enabling
dexterous and independent tissue manipulation, electrosurgical dissection, and visualization.
Clinical significance comes from the large number of patients who experience bladder cancer – 81,180 new
diagnoses per year in the USA alone [12] – as well as the high morbidity and mortality these patients face.
17,000 people die each year from the disease and tumors recur 78% of the time [47]. This is believed to be due
to the current need to remove the tumor piecemeal, rather than intact, which results in positive margins, spreads
cancer cells, and makes pathological assessment highly uncertain. Our system aims to enable tumors to be
removed intact, with no positive margins, and with muscle tissue attached, which will enable accurate, timely
diagnosis, with critical, urgently needed staging information.
The Innovation that enables our system to be so small is that we harness elastic interactions of curved tubes to
create miniature, dexterous surgical instruments that can bend and elongate. These instruments pass through
the port in an existing clinical transurethral endoscope to provide tentacle-like dexterity at its tip. Our system
is innovative because it provides dexterity and visualization at the 8.6mm diameter needed to pass through the
urethra, i.e. 1/4 the diameter of the smallest single port robots used clinically today. We hypothesize that providing
the surgeon with two hands that can move independently of the endoscope we will make intact removal of bladder
tumors more accurate. This will reduce positive margin rates and provide samples with muscle attached, which is
known to facilitate accurate staging. Also, because our system has dramatically fewer mechanical and electronic
components than current commercial surgical robots, it can be made approximately 10 times less expensive,
while still providing a healthy revenue stream and profit margin for our company.
Approach In our Phase I equivalent preliminary studies, we demonstrated that concentric tubes can be delivered
through an endoscope and controlled robotically by a surgeon. Leveraging these exciting preliminary studies,
in this direct to Phase II project, we convert our system into a clinical product and experimentally demonstrate
that it improves resection accuracy and facilitates obtaining intact specimens with negative margins and muscle
attached, in realistic phantom and cadaver studies. To do this, in Aim 1, we design an OR-ready support system
and perform benchtop verification of system accuracy. In Aim 2 we perform bot...

## Key facts

- **NIH application ID:** 10925417
- **Project number:** 5R44EB035063-02
- **Recipient organization:** VIRTUOSO SURGICAL, INC.
- **Principal Investigator:** Richard Joseph Hendrick
- **Activity code:** R44 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $908,121
- **Award type:** 5
- **Project period:** 2023-09-09 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10925417

## Citation

> US National Institutes of Health, RePORTER application 10925417, A Robotic System to Remove Bladder Tumors Intact: The Key to Making Lifesaving Treatment Decisions (5R44EB035063-02). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10925417. Licensed CC0.

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