(UroToday.com) Dr. Nicolas Soputro, a research fellow at the Cleveland Clinic, presented on the use of a robotic transurethral device for bladder tumor resection. He began by emphasizing that transurethral resection of bladder tumor (TURBT) remains the gold standard for bladder tumor treatment. However, he highlighted several limitations of conventional TURBT, including bleeding, perforation, electrocautery artifact, and the frequent absence of detrusor muscle in pathology samples.
Dr. Soputro then introduced the concept of robotic TURBT using an endoluminal robotic system as a potential solution to these challenges. He explained that their experimental platform, developed by Agilis Robotics, features a tissue grasper and a hook electrocautery device, both inserted through a 27Fr resectoscope sheath alongside a 12° 4mm rigid endoscopic camera (Figure 1).
Their experimental study involved five ex-vivo porcine bladder trials performed by surgical attendings and trainees, as well as a cadaveric trial conducted by an experienced robotic surgeon. The surgeons were tasked with resecting multiple regions of the bladder, including the posterior wall, anterior wall, bladder dome, and left and right lateral walls (Figure 2). Tissue samples were then submitted for pathological evaluation to assess for the presence of detrusor muscle and the extent of electrocautery artifact.
Reviewing their results, Dr. Soputro noted that in the porcine model, there was no statistically significant difference in resection outcomes between intravesical locations or between surgeons. Similarly, in the cadaveric model, no significant differences were found based on resection location. Importantly, pathology analysis confirmed detrusor muscle presence in all samples, with minimal electrocautery artifact observed.
He concluded by emphasizing that this was a pre-clinical experience study, and that Agilis Robotics is actively developing a suturing device attachment to further enhance the platform’s capabilities as it progresses toward clinical trials.
The session moderator praised the project, noting that TURBT has remained largely unchanged for over a century despite its limitations, particularly the risk of tumor cell dissemination during resection. He described this robotic platform as a glimpse into the future of bladder cancer surgery.
Figure 1. Intraoperative room configuration with the novel purpose-built transurethral robotic system.
Figure 2. The different resection sites during the robotic TURBT procedure on a female cadaver. The purpose-built robotic grasper was shown for its utility to provide additional retractions that allowed for improved specimen orientation and assessment of potential muscle invasion.
Presented by: Nicolas Soputro, MD, University of Melbourne, Research Fellow at Cleveland Clinic, @NicolasSoputro on X, during the 2025 Engineering & Urology Society (EUS) Annual Meeting on April 28, 2025, Las Vegas, Nevada
Written by: Harel C. Sims, B.S., University of California, Irvine, @SimsHarel on X, during the American Urological Association’s 2025 Annual Meeting, between April 26 – 29, 2025 in Las Vegas, NV.
