Characterization of resection dexterity in transurethral resection of bladder tumor: A kinematic study

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.