Transurethral resection of bladder tumors (TURBT) presents surgeons with challenges of limited tool dexterity. This paper investigates the limitations of dexterity and resection reach and accuracy within the intra-vesicular space of the bladder. The paper assumes the kinematics and geometry of current tools used for TURBT. The study presents a kinematic modeling framework and a simulation evaluation that aim to elucidate the limitations of current surgical tools. The kinematic framework also proposes a method for analyzing resection dexterity and accuracy in different regions of the bladder. The results demonstrate resection dexterity deficiencies in the areas neighboring the bladder neck and substantially higher dexterity in superior regions. In addition, the results of this work provide a currently missing quantified dexterity evaluation baseline for expected performance during manual TURBT against which future devices and robotic-assisted systems for resection can be compared.

Benign prostatic hyperplasia is the most common symptomatic disease in men. A new transurethral surgical intervention is available that has been shown to reduce bleeding, catheterization time, and hospitalization time in comparison to traditional Transurethral Resection of the Prostate (TURP). However, this new procedure, Holmium Laser Enucleation of the Prostate (HoLEP), is so challenging to accomplish that only a small number of expert surgeons are able to offer it. Toward facilitating broader use of HoLEP, we propose a new hand-held robotic system for the purpose of making the surgery easier to perform. In current HoLEP, the only way to aim the laser and/or manipulate tissue is to move the entire endoscope, stretching a large quantity of tissue. In contrast, our new robotic approach provides the surgeon with two concentric tube manipulators that can aim the laser and manipulate tissue simultaneously. The manipulators are deployed through a 5 mm working channel in a 26 French (8.66 mm) endoscope clinically used for transurethral procedures. This paper describes the design of the robot and experiments illustrating its ability to perform the motions expected to be useful in HoLEP.

Constrained motion control of robotic end-effectors is essential for safe operation in confined spaces such as the urinary bladder. This paper presents the clinical motivation for the development of new control algorithms for robotic-assisted transurethral bladder resection and surveillance using multisegment continuum robots. The anatomy, workspace, and access constraints for this procedure are identified and used as a guideline for the design of the telesurgical system and its control architecture. Constraints are mapped into the configuration space of the robot rather than in task space simplifying the modeling and the enforcement of virtual fixtures. The redundancy resolution is autonomously modified in order to exploit the remaining degrees of freedom using task priority. These methods are validated on a glass model of urinary bladder.