Transurethral resection of bladder tumor (TURBT) and pathological staging are both standard surgical therapies for non-muscle invasive bladder cancer and integral parts of the diagnostic evaluation and progression monitoring of all bladder tumors. TURBT is currently performed using straight resectoscopes and laser/cautery loops. Outcomes of TURBT are highly dependent on the experience and technical ability of the urologic surgeon and the location of the tumor. Anterior tumors are especially tricky to accurately resect due to the inability of straight surgical tools to curve up from the point of enty to the bladder. Surgeons currently rely on public pressure and resectoscope tilt to reach the frontal aspects of the bladder. However this technique has limited success in obese patients due to thick fat layer. Further, inadequate surveillance and tumor staging have been associated with misdiagnosed tumors and with a high recurrence rate. In addition, due to tool limitations, resection of tumors is carried out in a piece-meal fashion. This approach is hypothesized to possibly contribute to seeding new cancer locations and is counter indicative to the standard surgical practice of using en-block resection of tumors. Surgeons cannot validate this hypothesis due to lack of tooling that enables en-block resection. The short term goals of this Exploratory Bioengineering Research Grant (EBRG) focus on developing and evaluating new robots and tele-manipulation algorithms for improving dexterity, accuracy, and reliability of bladder surveillance and resection.
The specific aims of this research are: 1. Design a rapidly deployable sensory and surgical intervention telemanipulation slave for transurethral bladder resection and surveillance, 2. Integrate this surgical slave into a telemanipulation system with high level telemanipulation assistive algorithms, 3. Evaluate this integrated system for transurethral bladder resection. Fulfillment of these specific aims will shed light on the potentia of robot-assisted bladder resection for improving quality and accuracy of bladder resection and the possibility of using this new technology to enable en-block resection. The long term goal of this EBRG is to provide patients with the benefits of a more accurate alternative to bladder resection and surveillance that in turn is expected to reduce misdiagnosis rates, minimize need for re-resection, and improve prognosis. This long term goal is in accordance with the mission of the National Health Institute since it focuses on improving patient outcome, reducing morbidity, and providing new tools for biomedical research. Successful completion of this proposed research has an expected broader impact of providing surgical technologies relevant for general trans-luminal surgery, trans-gastric, trans-uterine surgery, and trans-anal surgery.

Public Health Relevance

This project focuses on enabling higher precision, safer, and more dexterous resection and surveillance of bladder tumors. Current surgical tool limitations hinder accurate and complete tumor resections and visualization;result in improper staging and increase rates of perforations and tumor recurrence. The proposed technology will reduce surgeon burden, improve resection accuracy, and hopefully reduce recurrence rates, trauma, and patient treatment cost.

National Institute of Health (NIH)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Exploratory/Developmental Grants (R21)
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Bioengineering, Technology and Surgical Sciences Study Section (BTSS)
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Krosnick, Steven
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Vanderbilt University Medical Center
Schools of Medicine
United States
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Sarli, Nima; Marien, Tracy; Mitchell, Christopher R et al. (2017) Kinematic and experimental investigation of manual resection tools for transurethral bladder tumor resection. Int J Med Robot 13:
Herrell, S Duke; Webster, Robert; Simaan, Nabil (2014) Future robotic platforms in urologic surgery: recent developments. Curr Opin Urol 24:118-26