Rethinking TURBT in the era of robotics
Novel robotic technology could make en bloc resection precise, practical and scalable in bladder tumor surgery.
Transurethral resection of bladder tumor (TURBT) is poised for a shift. Novel robotic technology makes transurethral en bloc resection of even muscle-invasive bladder cancer not just possible, but practical. Manual en bloc resection using conventional tools significantly reduces bladder cancer recurrence rates compared to traditional TURBT, but the procedure comes with a steep learning curve and is technically difficult.
“The Stern-McCarthy resectoscope was never designed to perform such advanced endoscopic surgery,” said Jeremy Teoh, MBBS, associate professor of urology at The Chinese University of Hong Kong, clinical director of urology and director of robotic services at CUHK Medical Centre, Hong Kong. “The concept of en bloc resection of bladder tumors (ERBT) has been proposed since 1980, but we definitely need a better tool to perform such precise and high-quality surgery.”
Dr. Teoh will deliver the 2026 John K. Lattimer Lecture: Transurethral Robotic en-bloc TURBT—Challenging the Status Quo today at 1 p.m. in Hall D. He will discuss the history of TURBT, the key barriers to oncologic success TURBT presents and a hands-on look at the robotic platform that can transform ERBT from an elusive goal to reality.
Most cystoscopes are 26 Fr in size, Dr. Teoh said, about 8.7 mm in diameter, too small to accommodate conventional robotic arms. The Virtuoso Endoscopic System uses nested, curved nitinol arms about 1 mm in diameter. The surgeon controls the arms and attached tools using two surgeon input devices at a workstation. The arms bend and rotate independently, enabling two-handed operations with precise control of cutting and retraction maneuvers to achieve uniform resection along the detrusor muscle layer.
The first-in-human trial was conducted in May 2025. There is a minimal learning curve for surgeons with prior laparoscopic and robotic experience, Dr. Teoh said.
The trial excised 12 bladder tumors en bloc in six patients with 100% technical success, 100% detrusor presence and, uniquely, pathologically evaluable clear surgical margins in the en bloc resection specimens. The mean operative time was 50.8 minutes, which Dr. Teoh noted is reasonable for a first-in-human trial and will likely markedly reduce with experience. There were no bladder perforations, no re-operations or mortality within 30 days and no ≥ grade 2 complications.
The Food and Drug Administration (FDA) granted breakthrough designation for the removal of bladder lesions. The designation identifies the technology as one that the FDA considers capable of improving disease management and patient care. Importantly, the designation enables potential improvements in reimbursement structure for breakthrough devices.
“Traditional transurethral surgery or resection is always destructive in nature,” Dr. Teoh said. “But in the future, we are working on inserting a needle holder for suturing, and transurethral reconstruction becomes highly feasible. This revolutionary robotic technology will allow us to perform surgeries that could not be achieved before.”
Procedures could include transurethral partial cystectomy, transurethral diverticulectomy and distal ureteric stricture excision and reimplantation. There are also potential applications in gynecology, pulmonology, otolaryngology, neurosurgery and other surgical specialties.
“Urologists have always been innovators in surgery and in robotics,” Dr. Teoh said. “As urologists, we have to get ourselves prepared for transurethral robotic surgery. Most importantly, we need to think and explore how we can use this novel robotic system to bring real clinical value to our patients.”
