Virtuoso Surgical Robotic System Marks First Case Milestone

Virtuoso Surgical Inc.’s robotics platform has made its clinical debut.

The company’s Virtuoso system was recently used by renowned bladder cancer surgeon and researcher Dr. Jeremy Teoh at The Chinese University of Hong Kong (CUHK). The Virtuoso system features two robotically controlled, needle-sized (< 1 mm) manipulators that operate from a rigid endoscope tip. The robotic system facilitated a series of endoscopic bladder lesion excisions using the advanced en bloc technique that removes the bladder lesion intact rather than piecemeal.

“We are excited to see the Virtuoso system used successfully in its first human cases, particularly to allow surgeons to provide patients a best-in-class procedure such as the en bloc bladder tumor resection,” Virtuoso Surgical CEO and urologic surgeon Dr. S. Duke Herrell said. “This milestone is a testament to our team’s dedication to advancing surgical robotics and our commitment to partnering with clinicians like Dr. Jeremy Teoh and CUHK to transform patient care. The Virtuoso system is engineered to empower surgeons with superior control and precision, which is critical for delicate operations.”

Dr. Teoh is an en bloc technique advocate; the technique reportedly offers significant advantages, including a reduced risk of tumor cell spillage, potentially helping to reduce the high recurrence rates of bladder cancer. Studies have also shown this approach helps to significantly enhance staging accuracy and improve pathological specimen quality.

A recent award-winning randomized controlled trial by Dr. Teoh et al. in European Urology demonstrated a decreased risk of cancer recurrence at one year with the manual en bloc technique. Despite noted benefits, en bloc procedures are not commonly performed in the United States, likely due to the dexterity limitations of current equipment, which makes the procedure challenging to learn and perform effectively. The Virtuoso system is specifically designed to overcome these challenges and was used to remove 11 lesions in six patients successfully.

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“The ability to perform an en bloc resection for bladder cancer with this level of robotic assistance is a game-changer even for an expert in the technique. The Virtuoso system offered exceptional maneuverability, dexterity and visual clarity, enabling meticulous dissection,” Dr. Teoh noted. “This approach has the potential to enable the widespread adoption of en bloc techniques, thereby minimizing local recurrence and providing a more definitive pathological specimen, which is crucial for guiding subsequent treatment decisions. We are extremely optimistic about what this technology means for the future of bladder cancer surgery and patient outcomes.”

The Virtuoso system’s advanced instrumentation and multiple-arm dexterity are designed to improve rigid endoscopy by providing retraction and precise control through the company’s patented concentric tube robotic arm technology. The concentric tube robot was an invention originally conceived by Vanderbilt University professor and Virtuoso Founder/President Robert J, Webster III, Ph.D., while part of a team of advanced medical robotics researchers at Johns Hopkins University. “Our vision at Virtuoso Surgical is to give surgeons unprecedented dexterity. This will enable them to perform the less invasive, more accurate surgeries that improve patients’ lives and long-term health outcomes,” Dr. Webster said.

This first-in-human use marks the beginning of a new phase for the Virtuoso system, as the company is planning to conduct expanded clinical trials and introduce new clinical applications across multiple additional surgical specialties. “We believe the Virtuoso system will be useful in multiple areas of the body where rigid endoscopes are used to deliver interventional tools,” Virtuoso Chief Operating Officer/Chief Technology Officer Richard J. Hendrick, Ph.D., noted. “Dexterous instruments at the tip of the endoscope that can work in small spaces have the potential to enhance existing procedures and enable entirely new, less invasive approaches.”

The company has already completed early feasibility studies in uterine fibroids, pulmonary procedures, and neurosurgery, and is exploring endoscopic spine procedures, among others. Virtuoso Surgical plans to continue advancing the technology in collaboration with Dr. Teoh and The Chinese University of Hong Kong team. The company plans to submit an IDE application to the U.S. Food and Drug Administration (FDA) to study and test the device’s use in the United States.

“We are unlike any surgical robot out there today. The Virtuoso system is designed for a different set of procedures and approaches that have not yet benefited from robotics,” Dr. Herrell added. “This is a new type of robot, significantly smaller in scale, which enables us to bring our surgical skills deep into the body with less invasiveness for the patient.”

Virtuoso Surgical has developed a robotic surgery system that improves minimally invasive endoscopic surgery. The Virtuoso system features a pair of instrument delivery arms made of concentric nitinol tubes that mimic a surgeon’s hand motions to offer unprecedented control and dexterity to a full range of endoscopic applications. The system utilizes patented technology initially developed by Virtuoso’s founders at Johns Hopkins University, Vanderbilt University, and Vanderbilt University Medical Center, with funding from the National Science Foundation and the National Institutes of Health. The device has not been approved by the FDA and is not for sale in the United States.