The Chinese University of Hong Kong (CUHK) has made a groundbreaking advancement in the field of urology by successfully performing the world’s first robotic-assisted en bloc resection of bladder tumours (ERBT) using a locally developed endoscopic surgical robotic system. This innovative procedure, which was first conducted in December of the previous year, has already been successfully performed on eight patients as of May 22, 2025.

Bladder cancer is a significant health concern, ranking among the top ten most common cancers worldwide. Approximately 75% of patients diagnosed with bladder cancer present with non-muscle-invasive forms of the disease, typically characterized by tumours measuring 3 cm or smaller. CU Medicine has previously established that ERBT is more effective than the conventional transurethral resection of bladder tumour (TURBT), showing a 40% reduction in tumour recurrence. This finding positions ERBT as a promising first-line surgical treatment for patients with smaller tumours. However, traditional ERBT procedures are heavily reliant on the surgeon’s skill and come with risks such as bleeding and bladder perforation.

In conventional manual ERBT, a cystoscope equipped with a built-in knife is inserted through the urethra into the bladder to remove tumours. The limitations of a single-arm instrument restrict the angle and direction of resection, necessitating constant adjustments to the cystoscope lens for optimal visibility. This complexity results in a steep learning curve, often requiring 30 to 50 cases for a surgeon to achieve proficiency.

The newly developed endoscopic surgical robotic system, known as the Agilis Robotics Intilume™ System, addresses these challenges with its fully flexible robotic arms. This system includes an endoscope holder, a robotic positioning cart, and a surgeon control chair, and it is compatible with various commercial endoscopes. The robotic instruments, which range from 2.8 mm to 3.5 mm in diameter, are designed for tissue retraction and dissection, offering movement in more than five directions. This flexibility allows for en bloc tumour resection even in confined spaces, enhancing the precision of the procedure. Surgeons can operate the system using remote controls, which improves procedural stability and reduces the risks associated with traditional methods.

Professor Kwok Ka-wai, a key developer of the Agilis Robotics Intilume™ System and a professor in the Department of Mechanical and Automation Engineering at CUHK, collaborated with the Department of Surgery at CU Medicine to conduct clinical trials that evaluated the system’s performance. He emphasized that the system’s unique fully flexible robotic arms make it suitable for a variety of endoscopic surgeries and directly compatible with standard hospital endoscopes. Looking ahead, Professor Kwok envisions the system being applied to treat gastrointestinal cancers, uterine conditions, and biliary diseases, where high precision and minimally invasive techniques are essential.

The urology team at CU Medicine’s surgery department has successfully performed robotic-assisted ERBT on eight bladder cancer patients between December of the previous year and April of the current year. All procedures resulted in complete tumour removal from the surgical margins, and patients were typically discharged within one to two days post-surgery. Among the six patients who completed 30 days of clinical observation, all showed satisfactory recovery.

Dr. Peter Chiu Ka-fung, an Associate Professor in the Division of Urology at CU Medicine, noted that the robotic system enhances the stability of ERBT operations, thereby reducing the risks of bleeding and perforation while improving surgical precision. This advancement not only lowers the likelihood of recurrence due to residual tumour tissue but also accelerates patient recovery.

Professor Ng Chi-fai, Tzu Leung Ho Professor of Urology at CU Medicine, highlighted that the novel robotic system is user-friendly, which aids young doctors in mastering ERBT more quickly. This ease of learning is expected to increase the number of trained doctors capable of performing ERBT, allowing bladder cancer patients to receive timely treatment.

In summary, the collaboration between CUHK’s Faculty of Medicine and the Department of Mechanical and Automation Engineering has led to a significant milestone in surgical technology with the introduction of the world’s first robot-assisted ERBT. Clinical trials have demonstrated promising outcomes, including enhanced precision and safety compared to traditional methods, with the potential to improve patient recovery and reduce recurrence rates. The system’s user-friendly design is anticipated to expand the availability of this advanced treatment, ultimately benefiting more patients in need of bladder cancer care.