Transurethral resection device, system and method of use

Abstract

Disclosed herein is a transurethral resection device. The device comprising: a housing defining a channel, the channel extending along an axial direction; a grasper assembly disposed in the channel, the grasper assembly being movable relative to the channel along the axial direction, the grasper assembly including: a grasper; a first elongated body; and a first continuum joint coupled between the first elongated body and the grasper; and a cutter assembly disposed in the channel, the cutter assembly being movable relative to the channel along the axial direction, the cutter assembly including: a cutter; a second elongated body; and a second continuum joint coupled between the second elongated body and the cutter, the second continuum joint being actuatable to displace the cutter in relative to the second elongated body, wherein the first continuum joint and the second continuum joint are actuatable independently of one another.

Description

TRANSURETHRAL RESECTION DEVICE, SYSTEM AND METHOD OF USECROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of priority to the Singapore application no. 10202400034R filed January 4, 2024, the contents of which are hereby incorporated by reference in their entirety for all purposes.TECHNICAL FIELD

[0002] This application relates to a medical device for urology, and more particularly to a transurethral resection device, a transurethral resection system, and a method of using the device and system.BACKGROUND

[0003] Transurethral resection of bladder tumor (TURBT) or bladder tissue generally involves resection of the non-muscle invasive bladder cancer (NMIBC). Although TURBT is conventionally performed less invasively using a resectoscope, which is equipped with a rigid telescope and an electrocautery tool, the recurrence rate of bladder cancer after TURBT is more than 60%. The high recurrence rate is believed to be due in part to incomplete removal of cancerous tissue as bladder tumors are typically removed in a piecemeal manner. However, en- bloc (larger size) removal of cancerous tissue using the current equipment may result in the resection being overly deep, causing bladder wall perforation.SUMMARY

[0004] According to an aspect, disclosed herein is a transurethral resection device. The transurethral resection device may comprise: a housing defining a channel, the channelextending along an axial direction; a grasper assembly disposed in the channel, the grasper assembly being movable relative to the channel along the axial direction, the grasper assembly including: a grasper defining a tip of the grasper assembly; a first elongated body defining a grasper body axis parallel to the axial direction; and a first continuum joint coupled between the first elongated body and the grasper, the first continuum joint being actuatable to displace the grasper relative to the first elongated body; and a cutter assembly disposed in the channel, the cutter assembly being movable relative to the channel along the axial direction, the cutter assembly including: a cutter defining a tip of the cutter assembly; a second elongated body defining a cutter body axis parallel to the axial direction; and a second continuum joint coupled between the second elongated body and the cutter, the second continuum joint being actuatable to displace the cutter in relative to the second elongated body, wherein the first continuum joint and the second continuum joint are actuatable independently of one another.

[0005] According to another aspect, disclosed herein a transurethral resection system. The transurethral resection system comprises: an irrigation sheath defining a device channel, the irrigation sheath comprising an irrigation inlet path and an irrigation outlet path; and the transurethral resection device as described above, the transurethral resection device fluid sealingly coupled to the device channel.

[0006] In yet another aspect, disclosed herein a method of operating the transurethral resection device as described above. The method comprises: gripping a target portion disposed on the target surface with the grasper; while holding onto the target portion using the grasper, moving the grasper away from the target surface along a grasper plane; and moving the cutter in a cutter plane to cut between the target portion and the target surface, wherein the cutter plane is orthogonal to the grasper plane.BRIEF DESCRIPTION OF THE DRAWINGS

[0007] Various embodiments of the present disclosure are described below with reference to the following drawings:

[0008] FIG. 1 is a schematic diagram of a transurethral resection system according to embodiments of the present disclosure;

[0009] FIG. 2 is a schematic illustration of the transurethral resection system and a transurethral resection device in use during a transurethral procedure according to various embodiments;

[0010] FIG. 3 shows a schematic illustration of the transurethral resection system according to various embodiments;

[0011] FIGs. 4A to 4D shows a transurethral procedure according to various embodiments;

[0012] FIG. 5 shows a perspective view and a detailed view (VIEW A) of a transurethral resection device according to various embodiments;

[0013] FIG. 6 shows a perspective view and a detailed view (VIEW B) of the transurethral resection device of FIG. 5 coupled to an irrigation sheath according to various embodiments;

[0014] FIG. 7 shows a partial side view of FIG. 6;

[0015] FIG. 8 shows a perspective view and a detailed view (VIEW C) of a transurethral resection device led to an irrigation sheath according to various embodiments;

[0016] FIG. 9 shows a front view of FIG. 8;

[0017] FIG. 10 shows a partial sectional view of FIG. 8;

[0018] FIG. 1 1 shows a perspective view of a grasper assembly according to various embodiments;

[0019] FIG. 12 is an exploded view of FIG. 11;

[0020] FIG. 13 shows a perspective view of a cutter assembly according to various embodiments;[0021 J FIG. 14 is an exploded view of FIG. 13;

[0022] FIGs.15A to 15C show exemplary tips of a cutter according to various embodiments;

[0023] FIGs. 16 and 17 show perspective views of a continuum joint according to various embodiments;

[0024] FIG. 18 shows perspective views of a disc of a continuum joint according to various embodiments;

[0025] FIG. 19 is a top view of FIG. 18;

[0026] FIG. 20 is a side view (VIEW D) of FIG. 18;

[0027] FIG. 21 is a side view (VIEW E) of FIG. 18;

[0028] FIGs. 22A and 22B show a rotation of a disc relative to an adjacent disc according to various embodiments;

[0029] FIGs. 23A to 23D show perspective views of a method of operating a transurethral resection system and a transurethral resection device according to various embodiments;

[0030] FIG. 24 is a side view of FIG. 23C;

[0031] FIG. 25 is a flowchart of a method of a method of operating a transurethral resection device;

[0032] FIG. 26A is a schematic diagram of a ROBERT system of an exemplary embodiment;

[0033] FIG. 26B shows the ROBERT system and an experimental setup in an operating room;

[0034] FIG. 26C shows an irrigation connections on an irrigation sheath;

[0035] FIG. 26D shows the distal end of the resectoscope of FIG. 26A;

[0036] FIG. 27A shows the assembly process of the robotic resectoscope;

[0037] FIG. 27B shows the assembled robotic resectoscope;

[0038] FIG. 27C shows the various degrees-of-freedom (DOFs) of the robotic resectoscope;

[0039] FIG. 27D shows the tendons at the wrist;

[0040] FIG. 27E shows the tendon movements and respective yaw and pitch movements, viewing along the x-axis;

[0041] FIG. 27F is an illustration of tendon routines inside the grasper and actuations via TSM;

[0042] FIG. 27G shows the complete assembly of instrument, motor housing and linear actuator;

[0043] FIG. 28A shows the local coordinates (LCs) in x0— z0plane;

[0044] FIG. 28B shows the LCs in x3— z3plane;

[0045] FIG. 28C shows the geometrical relations and displacements of the contact lines in x0— z0plane;

[0046] FIG. 28D shows the geometrical relations and displacements of the contact lines in x3— z3plane;

[0047] FIG. 28E shows the workspaces for the grasper and the cutter when 6C1— 0°;

[0048] FIG. 28F shows the workspaces for the grasper and the cutter when 6C1— 30°;

[0049] FIG. 29A shows the experimental setup for motion tracking of the gripper tip;

[0050] FIG. 29B is an illustration of measuring the wrist angle for yaw and pitch motions;

[0051] FIG. 29C shows an isometric view of the estimated workspace and the experimental results;

[0052] FIG. 29D shows a detailed view of the dashbox of FIG. 29C;

[0053] FIG. 29E shows the mean errors in displacement at 25 positions of the workspace;

[0054] FIG. 29F shows the standard deviation (STD) values at 25 positions of the workspace;

[0055] FGs. 30A to 30D shows the setup for force measurements and the results from the force measurements. FIG. 30A shows the setup for force measurements. FIG. 30B is aschematic diagram of the wrist force measurements. FIG. 30C is a schematic diagram of the grasping force measurements. FIG. 30D shows the average wrist forces of G3 at different wrist angles;

[0056] FIGs. 31A to 31H shows an ex-vivo experimental setup with porcine bladder. FIG. 31A shows the ex-vivo experimental setup with porcine bladder. FIG. 3 IB shows the locations where tissue cutting was targeted. FIGs. 31C to 3 IE are the scope views of en-bloc resections at posterior w all, dome and anterior neck. FIGs. 3 ID to 31H are the images of removed tissues from posterior wall, dome and anterior neck;

[0057] FIGs. 32A and 32B are the scope views of en-bloc resections at the posterior wall;

[0058] FIG. 32C shows the removed tissue from the posterior wall;

[0059] FIGs. 32D and 32E are the scope views of en-bloc resections at the anterior wall;

[0060] FIG. 32F is the images of removed tissues from the anterior wall;

[0061] FIG. 33 shows the components of aresectoscope according to various embodiments;

[0062] FIG. 34 shows the components of an irrigation sheath assembly according to various embodiments;

[0063] FIG. 35 shows an exploded view of a resection device according to various embodiments;

[0064] FIGs. 36A to 36D illustrates various discs with curved top and bottom surfaces and continuum arm with these discs. FIG. 36A is a horizontal plane view (from up direction) for yaw' (left-right) DOF. n(0i) and r2(02) forms a symmetrical and convex curve that describes the top curved surface. FIG. 36B shows the curve as asymmetrical, for example n(0i) =00and rr(02) = 1.75 mm . FIG. 36C shows the curve as symmetrical with constant curvature, for example n(0i) = r2<02) = 1.75 mm. FIG. 36D shows the curve as symmetrical with varying curvature, for example a parabola. Similarly, the bottom surface is determined by a concave curve.DETAILED DESCRIPTION

[0065] The following detailed description is made with reference to the accompanying drawings, showing details and embodiments of the present disclosure for the purposes of illustration. Features that are described in the context of an embodiment may correspondingly be applicable to the same or similar features in the other embodiments, even if not explicitly described in these other embodiments. Additions and / or combinations and / or alternatives as described for a feature in the context of an embodiment may correspondingly be applicable to the same or similar feature in the other embodiments.

[0066] In the context of various embodiments, the articles “a”, “an” and “the” as used with regard to a feature or element include a reference to one or more of the features or elements.

[0067] Tn the context of various embodiments, the term “about” or “approximately” as applied to a numeric value encompasses the exact value and a reasonable variance as generally understood in the relevant technical field, e.g., within 10% of the specified value.

[0068] As used herein, the term “and / or” includes any and all combinations of one or more of the associated listed items.

[0069] The term “pose” may include a position and an orientation of an object or part of an object. The term “position” may refer to a location or coordinate (for example, X-coordinate, Y coordinate, Z coordinate) of an object or part of an object in a space or a frame. The term “orientation” may refer to a facing or angle (for example, an X-direction vector, a Y-direction vector, a Z-direction vector) of an object or part of an object in a space or a frame.

[0070] The term “channel” may refer to an elongated space formed in a structure extending along an axis. The “channel” may have a regular cross-section along the axis. Alternatively, the channel may have a non-regular cross-section along the axis. The “channel” may also include multiple sub-channels, each defining a separate elongated sub-space.[0071 J As used herein, the term “transurethral” generally refers to a medical procedure performed or a medical device usable through the urethra. In some examples, it may refer to a surgery performed with a special instrument inserted through the urethra.

[0072] The present disclosure proposes a transurethral resection device and a transurethral resection system according to various embodiments. The transurethral resection device may be an elongated device. The transurethral resection device may be a miniatured device suitable for transurethral processes.

[0073] In various embodiments, the transurethral resection device may include multiple end effectors each actuatable to move relative to a datum, such as a housing or a guide member for the end effectors. The end effectors may each be configured to perform a specific function. In some embodiments, the end effectors may include a grasper and a cutter.

[0074] During a proposed transurethral resection process, the grasper may hold onto and lift a target tissue portion located on a target surface of the bladder. This may be followed by moving the cutter towards a neck or connecting portion between the target tissue portion and the target surface and to cut off the target tissue portion. In some embodiments, the neck or connecting portion may not be a narrowed structure, and hence, the cutter may be moved along a sweeping path to cut the connecting portion, often through a cyclic or periodic motion.

[0075] In various embodiments, the grasper may be displaceable to move in a grasper plane, and the cutter may be displaceable to move in a cutter plane, wherein the cutter plane is orthogonal to the grasper plane. Therefore, the grasper may generally be movable in an orthogonal plane from the cutter plane, and the cutter may generally be movable in an orthogonal plane from the grasper plane.

[0076] In various embodiments, the grasper may be configured with a larger movement space (or a larger angular displacement range) and the cutter may be configured with a relatively smaller movement space (or a limited angular displacement range). Therefore, the movementof the cutter may be limited according to requirements of the specific medical procedure. Limiting the movement of the cutter may mitigate the risk of accidental cutting or punctuating of adjacent tissue to the connecting portion. In addition, a larger movement for the grasper allows the target tissue portion to be held and lifted away from the target surface.

[0077] In various embodiments, to enable the above proposed transurethral resection process, each of the end effectors may be provided with a respective continuum joint. In various embodiments, a pose (including a position and an orientation) of the grasper may be varied by actuating the respective continuum joint. Similarly, a pose (including a position and an orientation) of the cutter may also be varied by actuating the respective continuum joint. In various embodiments, the continuum joint may be bent about two orthogonal axes. In an example, the corresponding continuum joint allows a pitch angle and a yaw angle of each of the grasper and cutter to be controllably varied. In various embodiments, each of the grasper and cutter may have 3 degrees-of-freedom (DOFs). In various embodiments, each of the grasper and cutter may have 5 DOFs.

[0078] In various embodiments, an endoscope may be provided during the execution of the transurethral resection process. Departing from other medical procedures in which the field of view of the endoscope is preferred to be unobstructed, the proposed transurethral resection device may be configured such that the end effectors (i.e., the grasper and the cutter) are constantly disposed in a field of view of the endoscope. This allows the operator (such as the physician) to have a more complete view of the lifting and cutting process as previously described.

[0079] FIG. 1 illustrates a transurethral resection system 50 according to various embodiments of the present disclosure. The transurethral resection system 50 may include a transurethral resection device 100 in signal communication with a controller 500. The controller 500 may be configured to control and to actuate the transurethral resection device 100.L0080J The transurethral resection device 100 may include a housing 110 defining a channel 112. In an exemplary embodiment, the housing 110 defines a maximum diametrical dimension of 7 millimetres. The channel 112 may extend along an axial direction 114. A grasper assembly 200 may be disposed in the channel 112. The grasper assembly 200 may be movable or extendable / retractable relative to the channel 112 along the axial direction 114. In addition, a cutter assembly 300 may be disposed in the channel 1 12. The cutter assembly 300 may be movable or extendable / retractable relative to the channel 112 along the axial direction 114.

[0081] In various embodiments, the grasper assembly 200 may include a grasper 210 which defines a tip of the grasper assembly 200. The grasper 210 may be configured in various forms, such as: a jaw gripper (as shown in FIG. 1), a coagulation gripper, an electrocautery forceps, a snare, a loop, etc. The grasper assembly 200 may further include a first elongated body 220 defining a grasper body axis 222, and a first joint or a first continuum joint 230 coupled between the first elongated body 220 and the grasper 210. The grasper body axis 222 may be parallel to the axial direction 114. The first continuum joint 230 may be actuatablc to displace the grasper 210 relative to the first elongated body 220.

[0082] In various embodiments, the cutter assembly 300 may include a cutter 310 which defines a tip of the cutter assembly 300. The cutter 310 may be configured in various forms, such as: an electrocautery cutter (as shown in FIG. 1), an ultrasonic blade, an electrocautery forceps, a surgical laser device, a scissor, etc. The cutter assembly 300 may further include a second elongated body 320 defining a cutter body axis 322; and a second joint or a second continuum joint 330 coupled between the second elongated body 320 and the cutter 310. The cutter body axis 322 may be parallel to the axial direction 114. The second continuum joint 330 may be actuatable to displace the cutter 310 in relative to the second elongated body 320.

[0083] In various embodiments, the grasper 210 and the cutter 310 may be configured as a similar or identical tool. For example, both the grasper 210 and the cutter 310 may be configuredas a respective electrocautery forceps. This provides a “tool symmetry” such that the grasper 210 may include the function of a cutter, and the cutter 310 may include the function of a grasper. With tool symmetry, the transurethral resection device 100 may be suited for use by both a right-handed user and a left-handed user. In addition, referring to FIG. 1, in various embodiments, the relative position of the grasper assembly 200 and the cutter assembly 300 may be swapped according to user preference. Therefore, this allows the transurethral resection device 100 may be customisable according to user requirements.

[0084] In various embodiments, the first continuum joint 230 and the second continuum joint 330 may be actuatable by an actuator 550 in signal communication with the controller 500. In various embodiments, the first continuum joint 230 and the second continuum joint 330 are actuatable independently of one another by the actuator 550.

[0085] The grasper assembly 200 may be actuatable to vary a first pose of the grasper 210, wherein the first pose comprising a first orientation and a first location of the grasper 210 relative to the housing 110. Similarly, the cutter assembly 300 may be actuatablc to vary a second pose of the cutter 310, wherein the second pose comprising a second orientation and a second location of the cutter 310 relative to the housing 1 10.

[0086] In various embodiments, the transurethral resection device 100 may further include an endoscope 140 disposed in the channel 112. The endoscope 140 may be positioned adjacent to the grasper assembly 200 and the cutter assembly 300.

[0087] FIG. 2 is a schematic illustration of the transurethral resection system 50 and the transurethral resection device 100 in use during a transurethral procedure. The transurethral resection system 50 may be operable to remove a target portion 92 (or target tissue portion) from a target surface 91 of a bladder 90.

[0088] According to various embodiments as shown in FIG. 3, the transurethral resection system 50 may further include a user interface 510 in signal communication with the controller500. The user interface 510 may include a user input 520 being configured to receive control commands from a user. In addition, the user interface 510 may include a display 530 for displaying a view of the endoscope 140 to the user. As shown in FIG. 3, in various embodiments, the grasper 210 and the cutter 310 may be disposed within a field of view of the endoscope 140.

[0089] FIGs. 4A to 4D shows schematically a method of operating the transurethral resection system 50 and the transurethral resection device 100 for non-muscle invasive bladder cancers. The bladder wall comprises multiple layers, arranged from the innermost to the outermost: the hning, submucosa, muscle, and fat layers. Given that the fat layer is easy to perforate by the cutter, such as a diathermy tool, the resections are carefully conducted within the muscle layer, avoiding penetration. The process of an en-bloc bladder tumor resection is as follows. Referring to FIG. 4 A, an irrigation sheath with an obturator is introduced into the bladder via the urethra. Subsequently, the obturator is removed, and the transurethral resection device is inserted. In various embodiments, an angle of attack for the resection may be adjusted accordingly by varying an orientation and position of the irrigation sheath. The surgical site may be fine-tuned by regulating the bladder volume through control of the irrigation sheath's flow rate. Referring next to FIG. 4B, the grasper may be employed to move and lift the bladder tumor (target portion) away from a target surface to reveal a connecting portion or a base. Referring to FIG. 4C, a cutter such as a diathermy tool may be used to cut or to resect the bladder tumor. To minimize the risk of residual cancerous tissue, the resection process may be performed with a negative surgical margin. When the surgeon's line of sight is obstructed or cannot ensure the cutting depth in the current location, the orientation and position of the transurethral resection device / irrigation sheath may be be adjusted. Tire cutting process may be repeated such that the bladder tumor is removed in an en-bloc manner, as shown in FIG. 4D.L0090J FIG. 5 illustrates a transurethral resection device 100 according to various embodiments of the disclosure. The transurethral resection device 100 may include a housing 110 defining a channel with multiple sub-channels 112a / l 12b / l 12c. The channel and subchannels 112a / l 12b / l 12c may extend along an axial direction 114. As shown in FIG. 5, a grasper assembly 200 may be disposed in the sub-channel 112a. The grasper assembly 200 may be movable or extendable / retractable relative to the sub-channel 1 12a along the axial direction 114. A cutter assembly 300 may be disposed in the sub-channel 112b. The cutter assembly 300 may be movable or extendable / retractable relative to the sub-channel 112b along the axial direction 114. An endoscope 140 may be disposed in the sub-channel 112c. The endoscope 140 may be positioned adjacent to the grasper assembly 200 and the cutter assembly 300.

[0091] In various embodiments, the grasper assembly 200 may include a grasper 210 which defines a tip of the grasper assembly 200. The grasper assembly 200 may further include a first elongated body 220, and a first continuum joint 230 coupled between the first elongated body 220 and the grasper 210. The first continuum joint 230 may be actuatablc to displace the grasper 210 relative to the first elongated body 220.

[0092] In addition, the cutter assembly 300 may include a cutter 310 which defines a tip of the cutter assembly 300. The cutter assembly 300 may further include a second elongated body 320; and a second continuum joint 330 coupled between the second elongated body 320 and the cutter 310. The second continuum joint 330 may be actuatable to displace the cutter 310 in relative to the second elongated body 320.

[0093] In various embodiments, the first elongated body 220 may define a grasper body axis 222. The grasper body axis 222 may be parallel to the axial direction 114. Similarly, the second elongated body 320 may define a cutter body axis 322. The cutter body axis 322 may be parallel to the axial direction 114. The endoscope 140 may define an endoscope body axis 142. The endoscope body axis 142, the grasper body axis 222 and the cutter body axis 322 may beradially spaced apart about the axial direction 114. In other words, the endoscope body axis 142, the grasper body axis 222 and the cutter body axis 322 may be offset from each other by an angular offset (see FIG. 9).

[0094] In various embodiments, the housing 110 may maintain a relative orientation between the first elongated body 220 and the second elongated body 320. In various embodiments, the grasper body axis 222 is spaced apart from and parallel to the cutter body axis 322.

[0095] In various embodiments, the first continuum joint 230 may be actuatable by a plurality of tendons or cables. In various embodiments, the second continuum joint 330 may be actuatable by a plurality of tendons or cables. In various embodiments, each of the plurality of tendons may be tensionable. Therefore, the transurethral resection system 50 may further include an actuator 550 operably coupled to the transurethral resection device 100. The actuator 550 may be a tendon tensioner being configured to independently actuate the grasper assembly 200 and the cutter assembly 300. In various embodiments, the first continuum joint 230 and the second continuum joint 330 may be actuated independently of one another and / or actuated concurrently by the tendon tensioner.

[0096] Referring to FIGs. 6 and 7, in various embodiments, the transurethral resection device 100 may be coupleable to an irrigation sheath 600 which defines a device channel 612. In various embodiments, the transurethral resection device 100 may further include a base 120 and a connector 130. The connector 130 may be coupleable to a coupling portion 630 of the irrigation sheath 600. Referring to FIGs. 6 and 7, the transurethral resection device 100 may enter the device channel 612 via a translational motion, follow by a rotational motion, coupling the connector 130 to the coupling portion 630 of the irrigation sheath 600. In one example, the coupling between the connector 130 and the coupling portion 630 may be a bayonet coupling,which enables a robust coupling with minimal relative motion between the housing 110 and the irrigation sheath 600 during use.

[0097] FIGs. 8 to 10 shows the transurethral resection device 100 in a coupled state with the irrigation sheath 600. In various embodiments, the irrigation sheath 600 may include an irrigation inlet path 640 to supply a liquid / fluid to a bladder through the irrigation sheath 600, and an irrigation outlet path 650 to expel liquid / fluid from the bladder. To mitigate or prevent leakages or seepages, the transurethral resection device 100 may be fluid sealingly coupled to the device channel 612. In other words, the transurethral resection device 100 may form a fluid seal with the device channel 612, such that fluid does not leak out via the connection between the transurethral resection device 100 and the irrigation sheath 600.

[0098] Referring to FIGs. 8, 9 and 10, the irrigation sheath 600 may include an inner sheath 610 coupled to an outer sheath 620. The inner sheath 610 may be coaxially coupled to the outer sheath 620, or in other words, the inner sheath 610 may share a common axial axis with the outer sheath 620. In various embodiments, the device channel 612 may be defined by an inner diameter of the inner sheath 610.

[0099] Referring to FIG. 9, in various embodiments, the inner sheath 610 and the transurethral resection device 100 may collectively define the irrigation inlet path 640. In various embodiments, the inner sheath 610 and the outer sheath 620 may collectively define the irrigation outlet path 650. In various embodiments, the outer sheath 620 may include multiple apertures or through holes, such that fluid may flow into the irrigation outlet path 650 from the bladder. It may be appreciated that by controlling respective flow rates in the irrigation inlet path 640 and the irrigation outlet path 650, a fluid volume in the bladder may be varied controllab ly.

[0100] FIGs. 11 and 12 show a grasper assembly 200 according to various embodiments.The grasper assembly 200 may be movable 201 (extendable or retractable) relative to thechannel 112 along the axial direction 114. This provides the grasper assembly 200 a first degree- of-freedom (DOF) of movement 201.

[0101] In various embodiments, the grasper assembly 200 may include a grasper 210 configured as a jaw gripper 210. The jaw gripper 210 may include a first jaw portion 211 pivotable 202 relative to a second jaw portion 212 to effect a grasping motion 215. This provides the grasper assembly 200 a second degree-of-freedom (DOF) of movement 202. The grasper assembly 200 may further include a first elongated body 220 defining a grasper body axis 222. In various embodiments, the grasper body axis 222 may be parallel to the axial direction 114 of the transurethral resection system 50. The first elongated body 220 may be rotatable 203 about the grasper body axis 222, for example, by a torque coil coupled to the actuator 550. This provides the grasper assembly 200 a third degree-of-freedom (DOF) of movement 203.

[0102] In various embodiments, the first elongated body 220 may be coupled to the grasper 210 via a first continuum joint 230. In an exemplary embodiment as shown in FIG. 11, the first elongated body 220 may be coupled to the first continuum joint 230 via a first connecting portion 224 of the first elongated body 220. The first continuum joint 230 may be actuatable by tendons 240 to displace 204 / 205 the grasper 210 relative to the first elongated body 220. The tendons 240 may pass through the first elongated body 220 and the first continuum joint 230 to be fixedly coupled to the grasper 210. In various embodiments, the tendons 240 may be independently actuated to vary a pulling force on the grasper 210, applying variable forces on the first continuum joint 230 to actuate the first continuum joint 230.

[0103] In various embodiments as shown in FIG. 1 1 , the first continuum joint 230 may be actuatable to move 204 the grasper 210 along a grasper plane 208 defined by orthogonal axes 83 and 87. In various embodiments, the first continuum joint 230 may bend 204 in the grasper plane 208 about axis 85. This provides the grasper assembly 200 a fourth degree-of-freedom(DOFs) of movement 204.[00104 J In some embodiments, the first continuum joint 230 may bend 205 in an orthogonal plane to the grasper plane 208 about axis 87. This provides the grasper assembly 200 a fifth degree-of-freedom (DOFs) of movement 205. Therefore, the first continuum joint 230 may be bendable about two orthogonal axes 85 / 87. The two axes 85 / 87 may be orthogonal to the grasper body axis 222.

[0105] FIGs. 13 and 14 show a cutter assembly 300 according to various embodiments. The cutter assembly 300 may be movable 301 (extendable or retractable) relative to the channel 112 along the axial direction 114. This provides the cutter assembly 300 a first degree-of-freedom (DOF) of movement 301.

[0106] In various embodiments, the cutter 310 may be configured as an electrocautery cutter 312. In other embodiments, the cutter 310 may be configured as a laser cauterisation cutter. As examples, the cutter 310 may include various geometrical forms, such as a triangular tip 312A (FIG. 15 A), a hook tip 312B (FIG. 15B), a straight tip 312C (FIG. 15C), etc.

[0107] The cutter assembly 300 may further include a second elongated body 320 defining a cutter body axis 322. In various embodiments, the cutter body axis 322 may be parallel to the axial direction 1 14 of the transurethral resection system 50. The second elongated body 320 may be rotatable 302 about the cutter body axis 322, for example, by a torque coil coupled to the actuator 550. This provides the cutter assembly 300 a second degree-of-freedom (DOF) of movement 302. In various embodiments, the second elongated body 320 may be coupled to the cutter 310 via a second continuum joint 330.

[0108] In various embodiments, the cutter assembly 300 may include a swivel joint 326 (FIG. 14) coupled between the second elongated body 320 and the second continuum joint 330. The swivel joint 326 may be rotatable or pivotable 303 about a swivel axis 327 to collectively move the cutter 310 and the second continuum joint 330 relative to the second elongated body 320. This provides the cutter assembly 300 a third degree-of-freedom (DOF) of movement 303.L00109J In an exemplar}' embodiment as shown in FIG. 13, the second elongated body 320 may be coupled to the second continuum joint 330 via a second connecting portion 324 of the second elongated body 320. The second continuum joint 330 may be actuatable by tendons 340 to displace 304 / 305 the cutter 310 relative to the second elongated body 320. The tendons 340 may pass through the second elongated body 320 and second continuum joint 330 to be fixedly coupled to the cutter 310. Tn various embodiments, the tendons 340 may be independently actuated to vary a pulling force on the cutter 310, applying variable forces on the second continuum joint 330 to actuate the second continuum joint 330.

[0110] In various embodiments as shown in FIG. 13, the second continuum joint 330 may be actuatable to move 304 the cutter 310 along a cutter plane 308 defined by orthogonal axes 83 and 85. Tn various embodiments, the second continuum joint 330 may bend 304 in the cutter plane 308 about axis 87. This provides the cutter assembly 300 a fourth degree-of-freedom (DOFs) of movement 304.

[0111] In various embodiments, the second continuum joint 330 may be actuatablc to displace the cutter 310 along a sweeping path 314 in the cutter plane. In some embodiments, the cutter 310 may move along the sweeping path 314 with varying speeds responsive to control of the second continuum joint 330 from the controller 500 and the actuator 550. In other embodiments, the second continuum joint 330 may be actuated to displace the cutter 310 along the sweeping path 314 periodically or cyclically.

[0112] In various embodiments, the cutter plane 308 may be orthogonal to the grasper plane 208 to enable a lifting and a cutting motion as described in previous sections.

[0113] In some embodiments, the second continuum joint 330 may bend 305 in an orthogonal plane to the cutter plane 308 about axis 85. This provides the cutter assembly 300 a fifth degree-of-freedom (DOFs) of movement 305. Therefore, the second continuum joint 330may be bendable about two orthogonal axes 85 / 87. The two axes 85 / 87 may be orthogonal to the cutter body axis 322.

[0114] In various embodiments, the first continuum joint 230 may be actuatable to move the grasper 210 within a grasper angular displacement range. The grasper angular displacement range may define a limit to the grasper movement. The grasper angular displacement range may be in the grasper plane 208. Similarly, the second continuum joint 330 may be actuatable to move the cutter 310 within a cutter angular displacement range. The cutter angular displacement range may define a limit to the cutter movement. The cutter angular displacement range may be in the cutter plane 308. In various embodiments, the grasper angular displacement range may be larger than the cutter angular displacement range.[001 15] In various embodiments, the first continuum joint 230 may be actuatable to move the grasper 210 away from the cutter body axis 322. Similarly, the first continuum joint 230 may also be actuatable to move the grasper 210 towards the cutter body axis 322.

[0116] In various embodiments, the second continuum joint 330 may be actuatablc to move the cutter 310 away from the grasper body axis 222. Similarly, the second continuum joint 330 may be actuatable to move the cutter 310 towards the grasper body axis 222.

[0117] FIGs. 16 to 21 illustrates a continuum joint according to various embodiments. It may be appreciated that the description of the continuum joint may be generally applicable to each of the first continuum joint 230 and the second continuum joint 330. Configurations of each of the first continuum joint 230 and the second continuum joint 330 may be configured according to requirements.

[0118] FIGs. 16 and 17 show respective perspective views of the continuum joint 230 / 330. The continuum joint 230 / 330 may include a plurality of discs 400 stacked in contact along a joint axis 232 / 332. The joint axis 232 / 332 of each continuum joint 230 / 330 may be coaxial with and parallel to the respective grasper body axis 222 and cutter body axis 322. The joint axis232 / 332 may be parallel to the axial direction 114. In various embodiments as shown in FIGs. 11 and 13, a plurality of tendons may pass through each of the plurality of discs 400. In various embodiments, each of the plurality of tendons may be tensionable.

[0119] Referring now to FIGs. 18 to 21, each disc 400 may define a respective disc axis 402. The disc axis 402 may define a centre axis of the disc 400. In various embodiments, each disc 400 may include a first curved surface 410 and an opposing second curved surface 420. The first curved surface 410 and the second curved surface 420 may be spaced apart along the disc axis 402.

[0120] In various embodiments, the first curved surface 410 may define a first ridge 412 with a first curvature. The first curvature may slope towards the second curved surface 420 from the first ridge 412. The first ridge 412 may intersect the disc axis 402. Similarly, the second curved surface 420 may define a second ridge 422 with a second curvature. The second curvature may slope towards the first curved surface 410 from the second ridge 422. The second ridge 422 may intersect the disc axis 402. In various embodiments, the first curved surface 410 and the second curved surface 420 may be configured to define an angle (a) between the first ridge 412 and the second ridge 422. In various embodiments, the angle (a) may be a right angle or 90 degrees. In various embodiments, the first ridge 412 may be orthogonal relative to the second ridge 422 about the disc axis 402. In various embodiments, each of the first ridge 412 and the second ridge 422 may be orthogonal to the disc axis 402.

[0121] In various embodiments as shown in FIG. 19, the disc 400 may include a plurality of first through holes 430 aligned with the first ridge 412. The disc 400 may include a plurality of second through holes 440 aligned with the second ridge 422. Each of the plurality of tendons 240 / 340 may be threaded through a respective one of: the plurality of first through holes 430 and the plurality of second through holes 440. In various embodiments, the disc 400 may furtherinclude a central through hole 450 which defines a path for further tendons and / or wires to be connected to the respective grasper 210 and cutter 310.

[0122] FIG. 20 shows a first side view (VIEW D) of the disc 400 illustrating the first ridge 412. FIG. 21 shows a second side view (VIEW E) of the disc 400 illustrating the second ridge 422.

[0123] In some embodiments, the disc 400 may include a single curved surface, such as a first curved surface 410 which defines a first ridge 412. The opposing second surface may be a flat or substantially flat surface. Such discs 400 may typically be disposed on the ends of the continuum joints 230 / 330.

[0124] In some embodiments, the plurality of first through holes 430 and the plurality of second through holes 440 may be rotationally symmetrical about the disc axis 402 (as shown in FIG. 19).

[0125] Referring to FIGs. 22A and 22B, in various embodiments, each of the plurality of discs may form a respective line contact with an adjacent one of the plurality discs. For example, referring to FIG. 22A, the disc 400a may form a line contact 405 with the adjacent disc 400b. In various embodiments, in response to a change in a tension to one or more tendons, the disc 400b may be actuated such that the line contact 405 shifts, as shown in FIG. 22B. Hence, for a continuum joint, selected ones of the respective line contact may shift in response to a change in a tension in at least one of the plurality of tendons.

[0126] FIGs. 23A to 23D illustrates method of operating the transurethral resection device 100 and the transurethral resection system 50. Referring to FIG. 23 A, grasper assembly 200 may be actuated to grip a target portion 92 (such as a tumor) disposed on a target surface 91 (such as a bladder wall) with the grasper 210. While holding onto the target portion 92 using the grasper 210, the grasper 210 may be moved away 204 or bent away from the target surface 91 along a grasper plane 208. The tissue between the target portion 92 grasped by the grasper210 and the rest of the bladder wall can be stretched by the bending or angular displacement of the grasper 210 with the channel 112 remaining substantially stationary. This enables the stretched tissue to intersect the path of the cutter 310 as the cutter is advanced in the axial direction 114. Referring next to FIG. 23B, the cutter assembly 300 may be actuated to move 304 the cutter 310 in a cutter plane 308 to cut between the target portion 92 and the target surface 91 . The cutter plane 308 may be orthogonal to the grasper plane 208. Referring next to FIG. 23C, the cutter assembly 300 may be actuated to displace or move the cutter 310 along a sweeping path 306 in the cutter plane 308. In some embodiments, the cutter 310 may be moved along the sweeping path 306 periodically. The sweeping path 306 is advanced towards the target portion 92 to achieve a separation of the target portion 92 from the target surface 91. In some examples, the cutter 310 cuts along an arcuate zig-zag path as the cutter 310 advances axially concurrently with a back and forth motion along the sweeping path 306. This enables the cutter 310 to remain within the field of view of the endoscope 140 throughout the cutting procedure.

[0127] Referring to FIG. 24, it may be appreciated that the cutting plane 308 is generally parallel to the target surface 91 with the cutter 310 moving within the cutting plane 308, and this reduces the risk of accidental puncture to the target surface 91 .

[0128] FIG. 25 is a flowchart of a method of operating a transurethral resection device 7000. The method 7000 comprises in frame 7100, gripping a target portion disposed on the target surface with the grasper; in frame 7200, while holding onto the target portion using the grasper, moving the grasper away from the target surface along a grasper plane; and in frame 7300, moving the cutter in a cutter plane to cut between the target portion and the target surface, wherein the cutter plane is orthogonal to the grasper plane.

[0129] Exemplary Embodiment - a Robot-Optimized Bladder Endoscopy Resection ofTumor (ROBERT)

[0130] In an exemplary embodiment, disclosed herein a Robot-Optimized Bladder Endoscopy Resection of Tumor (ROBERT) system. The ROBERT system is configured to facilitate efficient, comfortable, and safe transurethral en-bloc resection of tumors at various bladder regions. Rigid body approach with continuum end-effectors was employed with the incorporation of tendon-sheath mechanisms (TSM) to transmit loads from proximal motors to distal end-effectors. The configuration offers several advantages, including mobility, lightweight, small sizes, high force capacity, reliability, and safety.

[0131] Proposed Transurethral En-bloc Resection of Bladder Tumor (TUERBT) Procedure using ROBERT

[0132] The bladder wall is composed of several layers, from innermost to outermost: the lining, submucosa, muscle, and fat. The NMTBC typically originates in the lining or submucosa as shown in FIG. 4A. The proposed steps for TUERBT using the ROBERT system are shown in FIGs. 4B to 4D.

[0133] The procedure begins with the insertion of an irrigation sheath into the bladder via the urethra, similar to the conventional TURBT. Next, the dual-arm robot and endoscope are inserted and secured within the irrigation sheath. Then, the grasper grips the tumor, lifting it to stretch the nearby tissue (FIG. 4B). Following this, an electrocautery cutter is employed to excise the tumor base carefully, ensuring a negative margin (FIG. 4C). For large tumors, the orientation of the resectoscope may be manually adjusted to achieve the optimal angle for resection. These steps are repeated to perform the en-bloc resection with a negative resection margin, as depicted in FIG. 4D.

[0134] In the latest randomized multicenter phase 3 trial, patients with NMIBC of < 3cm, TUERBT resulted in a significant reduction in the 1-yr recurrence rate when compared with conventional resection. The study results support TUERBT as the first-line surgical treatment for patients with bladder tumor of < 3cm. However, about 12% of the patients in the TUERBTgroup eventually underwent conventional resection due to technical difficulty (e.g., location of tumor, morphology of tumor, etc.) as the conventional cutting electrocautery tool can only operate in limited planes. As such, a resectoscope, which has sufficient dexterity, multiple instruments, a larger workspace, and the ability to achieve a negative resection margin, will change the practice of NMIBC surgery as it will result in lower recurrence rate for NMIBC and establish higher success rate for TUERBT by overcoming the technical difficulty current surgical technique cannot achieve.

[0135] In addressing the above shortcomings, the ROBERT system is proposed. A schematic diagram of the ROBERT system is shown in FIG. 26A. The ROBERT system comprises the robotic resectoscope, main electronics and endoscopy tower. FIG. 26B shows the prototype and its setup in the operating room. The robotic resectoscope integrates a flexible endoscope (URF-V3, Olympus, Japan), a pair of irrigation sheathes (A22026A and A22040T, Olympus, Japan, as shown in FIG. 26C, a dual-arm robot, and a 3D-printed adaptor. FIG. 26D shows a close view of the robotic instruments. The resectoscope includes four tethered lines to the main electronics: (1) an endoscope connection to a video processor in the endoscopy tower, (2) electrical wires linking the bipolar the cutter tip to the electrocautery system (VIG300D, Erbe, USA. Settings: bipolar 60W, effect level 4), (3) TSM from the end-effector to the actuators, and (4) supply and drain hoses for saline irrigation connected to the irrigation sheathes (see FIG. 26C). The supply hose was attached to a hanging saline bag, while the drain hose was connected to a waste liquid tank on the floor.

[0136] The assembly process of the robotic resectoscope is outlined in FIG. 27A. First, the instruments of the dual arm robot and endoscope were inserted into the adaptor, which is then installed onto the irrigation sheathes. The fully assembled robotic resectoscope is shown in FIG.27B.[OO137J The distal end of the dual arm robot is illustrated in shown in FIG. 27C. The endeffectors are 3D printed using stainless steel 316L by the direct metal laser sintering (Protolabs, USA). Both robotic instruments have pitch (G2, C2), yaw (G3, C3), translation (G4, C4), and roll (G5, C5) movements, where “C” stands for cutter and “G” stands for grasper. The grasper also has an additional grasping DOF (Gl), while cutter features an additional pre-defined pinjoint (Cl ) for enhanced triangulation.

[0138] The pitch and yaw movements of the end-effectors are achieved by the hyper- redundant wrist, which consists of a stack of rolling-contact discs controlled by tendons. Each disc has curved top and bottom surfaces, with five vertical holes: a 0.8mm-diameter central hole for either Gl's tendons or the cutter’s electrical wires, and four 0.4mm -diameter side holes for the tendons. When a tendon (0.21 -mm-diameter stainless steel wire rope, SE-21 Sinyo, Japan, 55.9 N breaking strength) is pulled, the discs roll over adjacent ones to form a bend in the hyper- redundant wrist. This disc-type end-effector is preferred since it is easy to assemble and provides internal space for tendons or wires. FIG. 27E illustrates the tendon routines in the hyper-redundant wrist for the pitch and yaw movements. The actuation of the end-effector via TSM is depicted in FIG. 27F. Two motors control each DOF, with retracting one tendon while releasing the other one resulting in corresponding yaw, pitch, or gripping movements of the end-effector. The tendons from the end-effector pass through a protective sheath (OD 0.5 mm, ID 0.4 mm, Asahi-intecc, Japan) within the rigid tube section (length 34 cm, OD 2.4 mm, ID 2.1 nun, stainless steel). A 3D-printed reducer (stainless steel 316L) was used to connect the rigid tube and the torque coil (length 1 .0 m, OD 4.1 mm, ID 3.3 mm, Asahi-intecc, Japan). A larger sheath (length 1.2 m, OD 0.9 mm, ID 0.5 mm, Asahi-intecc, Japan) is used to protect the tendon in the torque coil. Each tendon's proximal end passes through a donut loadcell (LTH300, FUTEK, USA), then connects to the respective pulleys on the motors (2657W024CR with IERS3-500 encoder, Faulhaber, Germany). The loadcells and motors are connected to a controlboard (QPIDe, Quanser Inc., Canada). FIG. 27G illustrated the actuation for translation and roll movements. The translation (G4 and C4) of the 40mm range is achieved by a motorized linear slider (ARM46SMK, Oriental Motor, and KRF5 linear slider, THK). A motor mounted atop the slider enables end-effector’s ±180-degree roll movements (G5 and C5), transmitted through the torque coil.

[0139] The surgeon's hand movements, including yaw, pitch, gripping, roll, and translation were collected by a pair of haptic devices (Omega 7, Force Dimension, Switzerland), which serve as control inputs for the robotic instruments. An open-loop control algorithm was developed in Matlab Simulink to linearly scale these inputs to control the respective motors for the end-effector’s movements. Moreover, the tendons’ tension forces were monitored by the loadcells. If the user-defined maximum tension (20N) is exceeded, the respective motor was adjusted to maintain the maximum tension. Before operation or testing, all tendons are retracted to achieve IN pretension.

[0140] Estimating the Workspace of the Instruments

[0141] The workspace size or workspace dimension of the hyper-redundant wrist can be adjusted by modifying the disc dimensions and quantity. A longer wrist provides a larger workspace, minimizing the need for frequent repositioning of the resectoscope. However, this increased length also results in the endoscope being positioned further from the surgical site. To address this, a kinematic model was developed to estimate the workspace based on the geometric properties of the discs. Given that pretensions are applied on the tendons, the stack of discs is constrained by the tendons, two assumptions were made: (1 ) each disc rolls over the adjacent one without slipping, (2) each disc experiences the same rotational angle, implying that both pitch angle 0d G2and yaw angle 9^,63 are constant for all discs.

[0142] Using grasper as an example, there are 8 discs, with 10 rolling surfaces for pitch, and 8 for yaw. When the end-effector rotates by 0G2f°rpitch and 0G3for yaw, the rotation anglesof the discs were calculated as 0d G3= 0GS / 8 for yaw and 0d G2=0G2 / 1O for pitch, according to assumption (2). The movement ranges 0G3and 0G2for the end-effector were limited within ±80°. The discs had curved surfaces with radius of rdand a thickness of LDat the center. The top and bottom cylindrical surfaces was perpendicular to each other.

[0143] Next, the rolling disc contacts were modelled as combinations of pin joints and prismatic joints to construct the transformation matrix using Denavit-Hartenberg (DH) parameters. The DH parameters for the grasper arc listed in Table I. Here, ‘a’ and ‘a’ represent the translation and rotation along the local x-axis, while ‘d’ and ‘0’ represent the translation and rotation along the local z-axis. The local coordinate (LC) 0 is located at the bottom of the wrist's base, with Lorepresenting the height of the base. The related coordinates in discs 1 and 2 are labelled in FIGs. 28A and 28B, with the geometrical relations and the contact lines are shown in FIGs. 28C and 28D. As disc 1 rotates by yaw angle 0diG3at in FIG. 28A, the respective contact line shifts from P± to P1in the x0— z0plane. The superscript (•)* indicates the neutral location of the local coordinate when the wrist is straight. The displacements A, and A2from P^ to P±in FIG. 28C are expressed as:

[0144] Similarly, as shown in FIG. 28D, the second contact line (between the disc 1 and 2) shifts from P2to P2with displacements d3and d4:414The projected distance LPDfrom the first contact line to the second one at the axis x2is written as:LpD= LD— A2— A4(3)

[0145] LC 3 to 6 represents the transformations from the first rolling contact to the second one. Then, based on assumption (2), the DH parameters for LC 7 to 10, 11 to 14, and 15 to 18 are identical to those for LC 3 to 6. LC 20 is located at the distal tip, with L2being the distance from P19to the tip.[00146J The DH parameters for the cutter are detailed in Table 11, while dimensional parameters of the grasper and cutter can be found in Table III. Notably, the cutter has an additional rotational joint for yaw motion (Cl) before the wrist and it has fewer discs. Moreover, L±represents the length of the additional joint, and 6C1denotes its rotation angle.

[0147] The grasper and the cutter’s workspaces without translation and roll movements were obtained, as shown in FIGs. 28E and 28F. The joint Cl is indicated by white arrows. When Cl is configured to 9C1= 30°, part of the cutter work surface is moving to the right-hand side, resulting in a shifted workspace with better triangulation. Thus, the rotation angle of Cl is configured based on the surgeon's need before the procedure.Table IDH PARAMETERS OF THE GRASPERTable IIIPARAMETERS OF THE END-EFFECTORS

[0148] Experiments and Results

[0149] Motion Tracking Experiment for the End-effector

[0150] An optical marker was mounted at the tip of the grasper to track its position using four motion tracking cameras (Prime 13W, OptiTrack, USA) as illustrated in FIG. 29A.

[0151] First, the end-effector was straightened while IN pretension was applied on all tendons. After applying pretension, the tendon lengths were denoted as zero. Subsequently, tendons G3+ and G3- were retracted or released, while keeping tendons G2+ and G2- unchanged (as shown in FIG. 27E), to achieve a desired yaw angle (as shown in FIG. 29B). The respective tendon lengths hG3+and iG3_ were recorded and are presented. Positive tendon length represents releasing the respective tendon, while negative value indicates retraction. After each movement, the instrument was returned to its initial pose. This procedure was repeated for yaw angles:0G3= 80°, 40°, — 40°, — 80°. Similarly, the end-effector’s wrist was also bent to achieve different pitch angles 0G2= —80°, —40°, 40°, 80°. Through this process, the relationship between tendon lengths and wrist angles for pure yaw and pitch movements at±40° and +80° was established.

[0152] By combining these tendon adjustments (LG2+and LG2_ for yaw and LG2+and LG2_ for pitch), the grasper’s distal tip was able to reach 25 points, covering the entire workspace. The distal tip positions were obtained by the motion tracking system. This process was repeated five times.

[0153] The tracking results are shown in FIG. 29C, with a detailed zoomed-in view of a point from five runs presented in FIG. 29D. The experimental values were compared with values estimated by the proposed model. The errors in the displacement of the 25 positions are presented in FIG. 29E. The mean error in displacement is 2.08 mm, about 12% of the endeffector length. The standard deviations (STD) of the 25 positions are presented in FIG. 29F. The STD values range from 0.03 mm to 0.19 mm. The low STD values indicate that the movements of the robotic instrument are highly repeatable, demonstrating consistent wrist performance.

[0154] Experiments and results - Wrist and grasping force

[0155] The force exerted by G3 were measured using a test bed, as shown in FIGs. 30A and 30B. The inset provides a schematic diagram of the wrist force measurement setup. Wrist forces for G3 were measured at various wrist angles (0°, 10°, 20°, 30°, or 40°) which were determined using a protractor. The cable was used to connect the fixed jaw and a load cell (LTH300. FU EK , with the grasper's shaft, cable, and the center of the load cell aligned in the same horizontal plane. The proximal tendon tension was maintained at 20 N, resulting in the maximum wrist angle. Then, the load cell was moved to bend the continuum structure to the desired wrist angle and keep the cable perpendicular to the gripper. Its reading at the desired wrist angle was recorded, and the measurement was repeated three times for all joint angles. The average values are plotted in FIG. 30D. The maximum average wrist force is 0.48±0.02 N at 0°, decreasing to 0.12+0.01 N at 40°. Since G2 have similar structures as G3, its wrist force is expected to be similar. Therefore, the grasper should ideally approach the target with a straight posture. The schematic diagram of grasp force measurement is presented in FIG. 30C. The grasper was fixed from the continuum wrist to the holes for crimping beads on the fixed jaw, only allowing the jaw to move. The cable was connected to the middle point of the moving jaw, and proximal tendon tension was maintained at 20 N on the closing tendon. Then, the loadcell was moved to pull the moving jaw open. Its reading when the moving jaw was open was recorded as the maximum grasping force. The average value of six measurements was 0.69 N, which is low compared to those large-diameter surgical graspers used in colonoscopy and laparoscopy. However, manipulating forces required for the bladder tissue varies as the instrument's size changes. When the bladder is fully filled, the tissue tension is high, the wall is thinner, and more grasping and wrist force is required. On the other hand, when the bladder is half-filled, the tissue tension is low, and the wall is thicker, so less grasping and wrist force is needed. Thus, there is a need to evaluate the grasping performance in the ex-vivo experiments.

[0156] Experiments and results - Ex-vivo Experiment

[0157] To evaluate the en-bloc resection capability of the robotic resectoscope system, ex- vivo tissue resection experiments were conducted using the bladder from 60-70 kg female porcine. The ex-vivo experimental setup is shown in FIG. 31 A. En-bloc tissue resection was performed at the posterior wall, dome, and anterior neck as FIG. 3 IB. For the anterior neck, resection was performed from a position 3 cm away from the urethra. The anterior neck presented a challenging angle of attack of approximately 0°, which made grasping difficult. The dome required an angle of attack of 90°, complicating the cutting process. In contrast, the anterior and posterior walls provided an angle of approximately 40°, which is suitable for both cutting and grasping.

[0158] The volume of the bladder was controlled by adjusting the supply and drain valves of the irrigation sheath. A half-filled bladder results in a shorter distance from the end-effector to the anterior wall and ensured that the wall thickness was not too thin, thereby minimizing the risk of perforation during resection. The irrigation function allows the surgeon to make additional adjustments on the surgical site.

[0159] The surgical site was marked by injecting dye ink (Indigo carmine, Sigma-aldrich, Germany) between the muscle and mucosa layers. Then, the bladder was expanded and therobotic resectoscope was inserted. The resectoscope and bladder volume were adjusted to reach the marked surgical site. Then, the TUERBT procedures described in FIGs. 4B to 4D were performed.

[0160] Endoscopic views during operation are presented in FIGs. 31C to 3 IE, while the resected tissues are presented in FIGs. 3 IF to 31H. For all experiments, one piece of tissue with approximately 10x10 mm with 2~3 mm thickness was removed. The muscle tissues were observed during resection as marked in FIGs. 31C to 3 ID. These results demonstrate that the grasping and wrist forces were sufficient for tissue manipulation and successful completion of the TUERBT procedure in this experimental setting. Additionally, no leakage or perforation was observed following tissue resection. The robotic resectoscope was operated by an engineer with ten hours of training. Resections of the posterior wall and anterior neck took roughly 10 minutes each, while resection at the dome took approximately 25 minutes.

[0161] Experiments and results - In-vivo Experiment

[0162] An in-vivo study in a 59 kg porcine model was conducted to demonstrate the feasibility of ROBERT in an actual surgical operation scenario. This animal study was reviewed and approved by the Institutional Animal Care and Use Committee (IACUC) of the National University of Singapore. FIG. 26B shows the experimental setup inside the operation room. The main electronics cart was placed in line with the operating table, and the surgeon console and endoscopy tower were placed at two sides of the main electronics cart. The scope holder was fixed on the surgical table. The porcine under anaesthesia was placed in the supine position on the surgical table with its head away from the main electronics cart.

[0163] Initially, a guidewire and an endoscope were inserted into the bladder via the urethra. Subsequently, the endoscope was withdrawn, and a dilator was then inserted over the guidewire to dilate the urethra. Following this, the irrigation sheathes were inserted over the guidewire and dilator, and the endoscope was reintroduced together inside the irrigation sheath to visuallyconfirm the placement of the irrigation sheath in the bladder. Once confirmed, the endoscope, dilator, and guidewire were removed. The endoscope was then assembled into the adaptor alongside the dual-arm robot. This adaptor assembly was inserted into and coupled with the irrigation sheathes. The bladder was inflated by activating the supply valve of the irrigation sheath, and the resectoscope’s orientation was adjusted to access the posterior wall.

[0164] The proposed TUERBT procedures were then performed to remove a piece of tissue from the bladder wall, as shown in FIG. 32A. After successful resection FIGs. 32B and 32C, the adaptor assembly was extracted to retrieve the excised tissue. Next, the adaptor assembly was reassembled and the resectoscope was repositioned for the anterior wall. The irrigation was manually adjusted to control the bladder volume and bring the posterior wall towards the resectoscope. The proposed TUERBT procedures were repeated, as shown in FTGs. 32D to 32F.

[0165] In this in-vivo study, two en-bloc resections were successfully performed without interruption: the first from the posterior wall (5x5 mm) and the second from the anterior wall (4x4 mm). The robotic grasper demonstrated sufficient payload capacity to grasp and lift the tissue, as shown in FIGs. 32A and 32D. The resections were completed by a surgeon in eight and six minutes, respectively. The surgeon confirmed that both resections reached the muscle layer, as evidenced by the exposure of muscle fibers at the resected sites. Furthermore, there were no instances of tissue slippage, electrical leakage, or unexpected system shutdown during the procedures.

[0166] As an alternative description, the present disclosure is related to a resection module comprising an end-effector. The module may be assembled with other components to form a resectoscope which allows for the resection of a tumour in an en-bloc manner with the payload and dexterity to manipulate the tissue around the tumour. This may facilitate efficient, comfortable, and safe transurethral en-bloc resection of tumours at various bladder regions. The present disclosure also concerns a resectoscope having the disclosed resection module. Themodule allows for a reduction in procedure duration which may lead to shorter recovery time, less pain / discomfort and reduced risk of complication. The module may also have improved surgical precision. The module may be used with existing endoscopy instruments such as irrigation sheaths, which may provide proper water circulation to ensure safe pressure inside the bladder and clear vision during operation. The module may be tele-operated by a surgeon.

[0167] Accordingly, the present disclosure concerns a resection module, comprising: a) an end-effector at an end of the resection module thereof; b) a plurality of discs having at least a curved surface, the end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the end-effector.

[0168] As shown in the figures, the resection module comprises an end-effector. A first resection module comprises a first end-effector configured to grip the tumour. A second resection module comprises a second end-effector configured to ablate the tumour. The first end-effector is able to grip and lift the tumour and the second end-effector is able to make incisions for the removal of the tumour. The procedure duration from the first grip to full resection may be within six minutes.

[0169] The module utilises a plurality of discs having at least a curved surface and at least one tendon, preferably at least three tendons, passing through the plurality of discs for actuating the end-effector. The plurality of discs having at least a curved surface forms a continuum wrist in the end-effector. A continuum wrist or joint in an end-effector is one where the end-effector is able to bend continuously along their length and is able to operate in confined spaces due to their compactness and flexibility. When the tendon is pulled, the discs roll over their adjacent discs without bending any parts of the discs to form a bend along the end-effector. When the discs roll over the adjacent contacting discs as the end-effector is bent, the line of contact shifts. Hence, each disc is a combination of a prismatic and rotational joint. Each disc rolls over thenext contacting disc without slip and each disc has an equal rotational angle for each rotational axis and the curvature of the continuum wrist is constant throughout. The arrangement of the plurality of discs with the at least one tendon may prevent the snapping motion and motion hysteresis due to friction in-between tubes in other concentric-tube designs and may prevent unexpected motion and position inaccuracy. The dexterity and pay load of the device may be maintained allowing for en-bloc tumour resection.

[0170] The resection module may be attached to pre-existing endoscopes, sheaths and / or obturator. The resection module may be fitted or assembled to form a resectoscope. When two resection modules are combined to give a first end-effector and second end-effector, the modules may both fit into existing irrigation sheaths which may be compatible to a pre-existing endoscope. Tn some embodiments, the plurality of discs are stacked on top of each other along a longitudinal axis of the resection module. The discs are stacked on top of each other so as to form a continuum wrist in each end-effector. This longitudinal axis is also the x axis of the local Cartesian coordinate. The origin of the local Cartesian coordinate locates at the centre of the discs, and z-axis is pointing upward. The discs may be constrained by the at least one tendon passing through the stacked discs. The discs may be stacked such that the discs roll over the adjacent contacting disc when the end-effector is bent.

[0171] In some embodiments, the plurality of discs have a single curved top surface and a flat bottom surface. A single curved surface is a surface that has a single curvature with its radius in one plane. There are two perpendicular directions at a point on a single curved surface where one has a non-zero curvature and the other has zero curvature. Examples of single curved surfaces include a cylinder or a cone.

[0172] In some embodiments, the plurality of discs are stacked on top of each other such that a disc's flat bottom surface is aligned and in contact with its neighbouring disc's flat bottom surface, wherein a curvature of the single curved top surface of the disc is rotated 90° relativeto the curvature of the single curved top surface of the neighbouring disc, when viewed from a longitudinal axis of the resection module.

[0173] In some embodiments, the plurality of discs have a single curved top surface and a single curved bottom surface, wherein a curvature of the single curved bottom surface is rotated 90° relative to the single curved top surface. This may be visualised when viewed from a longitudinal axis of the resection module.

[0174] In some embodiments, the plurality of discs are stacked on top of each other such that a disc’s curved top surface is aligned and in contact with its neighbouring disc’s curved bottom surface, with a line of contact intersecting with and is perpendicular to a longitudinal axis of the resection module. This results in a straight continuum wrist, which is the neutral position. The discs are stacked on top of each other such that when the continuum arm bends, the line of contact shifts along the single curve and becomes aligned with the direction that has zero curvature without intersecting the longitudinal axis.

[0175] In some embodiments, the plurality of discs arc each characterised by one curve at a horizontal plane (x-y plane) and one curve at a vertical plane (x-z plane). The surfaces are created by sweeping the curve along y axis (in x-z plane) or along z axis (in x-y plane). The adjacent surfaces (for example, a disc’s curved top surface and its neighbouring disc’s curved bottom surfaces) are in the same plane, while the disc’s bottom surface is at another plane comparing with the disc’s top surface.

[0176] In some embodiments, the curved top surface and curved bottom surface are symmetrical or asymmetrical with respect to a longitudinal axis along the resection module. The curve may be a circle (FIG. 36C), a parabola curve (FIG. 36D) or an asymmetric curve (FIG. 36B). In some embodiments, the curved top surface is convex and the curved bottom surface is concave. The curved surfaces may be identical or different for all surfaces, which may lead to changes of final moving ranges of the continuum wrist.

[0177] In some embodiments, each disc comprises at least one through-hole parallel to a longitudinal axis of the disc for the tendon passing through the plurality of discs. In some embodiments, each disc comprises at least one through-hole parallel to a longitudinal axis of the resection module for the tendon passing through the plurality of discs. This keeps an internal space for tendons to pass through the end-effector which may minimise the size of the device.

[0178] Tn some embodiments, each disc comprises at least two through-holes, at least three through-holes, or at least four through-holes. In some embodiments, each disc comprises five through-holes parallel to a longitudinal axis of the disc. In some embodiments, each disc comprises five through-holes parallel to a longitudinal axis of the resection module. This allows multiple tendons to pass through the plurality of discs, which in turn allows for controlling of multiple degree of freedoms.

[0179] In some embodiments, each disc comprises a middle through-hole and four through holes circumferentially positioned around the middle hole. A tendon passing through the middle through-hole may control the degree of freedom of the end-effector. The tendon may pass through any of the four auxiliary through-holes and two electric wrap wires may pass through the middle through-hole. A tendon passing through at least one of the four through-holes circumferentially positioned around the middle through-hole may control the degree of freedom for bending angles independently in the end-effector. The tendon controlling the degree of freedom for bending angles may actuate the end effector in the vertical direction perpendicular to a longitudinal axis of the resection module. Another tendon controlling the degree of freedom for bending angles may actuate the end-effector in a horizontal direction parallel to the longitudinal axis of the resection module.

[0180] The through-hole diameter may be dependent on the material strength and the manufacturing methods. It may also be dependent on the tendon passing through the through- hole to achieve various degree of freedoms. For example, the disc may be 3D printed with aminimum wall thickness of about 0.2 mm. In some embodiments, the at least one through-hole is characterised by a diameter of about 0.2 mm to about 1.0 mm. In other embodiments, the diameter is about 0.2 mm to about 0.8 mm, about 0.2 mm to about 0.6 mm, about 0.2 mm to about 0.4 mm, about 0.4 mm to about 1.0 mm, or about 0.4 mm to about 0.8 mm. In some embodiments, the diameter is about 0.4 mm to about 0.6 mm.

[0181] In some embodiments, the middle through-hole is characterised by a diameter of about 0.6 mm to about 1.0 mm. In other embodiments, the diameter is about 0.6 mm to about 0.9 mm, about 0.6 mm to about 0.8 mm, about 0.7 mm to about 1.0 mm, about 0.7 mm to about 0.9 mm, about 0.7 mm to about 0.8 mm, about 0.8 mm to about 1.0 mm or about 0.8 mm to about 0.9 mm. In some embodiments, the middle through-hole is characterised by a diameter of about 0.8 mm.

[0182] In some embodiments, each of the four through-holes circumferentially positioned around the middle hole is characterised by a diameter of about 0.2 mm to about 0.6 mm. In other embodiments, the diameter is about 0.2 mm to about 0.5 mm, about 0.2 mm to about 0.4 mm, about 0.3 mm to about 0.6 mm, about 0.3 mm to about 0.5 mm, about 0.3 mm to about 0.4 mm, about 0.4 mm to about 0.6 mm or about 0.4 mm to about 0.5 mm.

[0183] In some embodiments, each of the four through-holes circumferentially positioned around the middle hole is characterised by a diameter of about 0.4 mm. The four circumferential through-holes may be sized to be smaller than the middle through-hole. This increases the strength of the disc. In some embodiments, when 3D printing techniques are used in the manufacturing of the discs, the wall thickness between the through-holes may be at least about 0.2 mm. In other embodiments, the thickness may be at least about 0.3 mm, at least about 0.5 mm, at least about 0.7 mm, at least about 1 mm.

[0184] The thickness of each disc may be adjusted to achieve various moving range or height of the end-effector. In some embodiments, each disc is characterised by a thickness of about0.5 mm to about 1.5 mm. In other embodiments, the thickness is about 0.5 mm to about 1.3 mm, about 0.5 mm to about 1.1 mm, about 0.7 mm to about 1.5 mm, about 0.7 mm to about 1.3 mm, or about 0.7 mm to about 1.1 mm. In some embodiments, the thickness is about 0.75 mm to about 1.1 mm.

[0185] In some embodiments, each disc is characterised by a thickness of about 0.5 mm to about 1 .0 mm. In other embodiments, the thickness is about 0.5 mm to about 0.9 mm, about 0.5 mm to about 0.8 mm, about 0.6 mm to about 1.0 mm, about 0.6 mm to about 0.9 mm, about 0.6 mm to about 0.8 mm, about 0.7 mm to about 1.0 mm, about 0.7 mm to about 0.9 mm, or about 0.7 mm to about 0.8 mm. In some embodiments, the disc is characterised by a thickness of about 0.7 mm to about 1.5 mm. In other embodiments, the thickness is about 0.7 mm to about 1 .3 mm, about 0.7 mm to about 1 .1 mm, about 0.9 mm to about 1 .5 mm, about 0.9 mm to about 1.3 mm, about 0.9 mm to about 1.1 mm, about 1.1 mm to about 1.5 mm, or about 1.1 mm to about 1.3 mm.

[0186] In some embodiments, each disc is characterised by a thickness of about 0.75 mm. In some embodiments, each disc is characterised by a thickness of about 1.1 mm. The top or bottom surface of each disc is curved and has a radius of curvature. A radius of curvature is the radius of a circle with an arc which would most closely approximate the part of the curve surface. The radius of curvature may affect the moving range of the end-effector. The surface of the disc may be smooth and may have a varying radius of curvature or a constant radius of curvature. In some embodiments, the top or bottom surface of each disc is characterised by a radius of curvature of about 0.5 mm to infinity.

[0187] In some embodiments, the top or bottom surface of each disc is characterised by a radius of curvature of about 0.5 mm to about 10.0 mm. In other embodiments, the radius of curvature is about 0.5 mm to about 8.0 mm, about 0.5 mm to about 6.0 mm, about 0.5 mm to about 4.0 mm, about 0.5 mm to about 2.0 mm, about 0.5 mm to 35 about 1.9 mm, about 0.5mm to about 1.8 mm, about 0.6 mm to about 10.0 mm, about 0.6 mm to about 8.0 mm, about 0.6 mm to about 4.0 mm, about 0.6 mm to about 2.0 mm, about 0.6 mm to about 1.9 mm, about 0.6 mm to about 1.8 mm, about 0.7 mm to about 10.0 mm, about 0.7 mm to about 8.0 mm, about 0.7 mm to about 6.0 mm, about 0.7 mm to about 4.0 mm, about 0.7 mm to about 2.0 mm, about 0.7 mm to about 1.9 mm, about 0.7 mm to about 1.8 mm, about 0.8 mm to about 2.0 mm, about 0.8 mm to about 10.0 mm, about 0.8 mm to about 8.0 mm, about 0.8 mm to about 6.0 mm, about 0.8 mm to about 4.0 mm, about 0.8 mm to about 2.0 mm, about 0.8 mm to about 1.9 mm, or about 0.8 mm to about 1.8 mm. In some embodiments, the radius of curvature is about 0.5 mm to about 1.75 mm.

[0188] In some embodiments, the top or bottom surface of each disc is characterised by a radius of curvature of about 1.3 mm to about 2.0 mm. In other embodiments, the radius of curvature is about 1.3 mm to about 1.9 mm, about 1.3 mm to about 1.8 mm, about 1.5 mm to about 2.0 mm, about 1.5 mm to about 1.9 mm, about 1.5 mm to about 1.8 mm, about 1.7 mm to about 2.0 mm, about 1.7 mm to about 1.9 mm, about 1.7 mm to about 1.8 mm, about 1.8 mm to about 2.0 mm, or about 1.8 mm to about 1.9 mm.

[0189] In some embodiments, the top or bottom surface of each disc is characterised by a radius of curvature of about 1.75 mm. In some embodiments, the top or bottom surface of each disc is characterised by a radius of curvature of about 0.8 mm. Alternatively, the top or bottom surface of each disc may be characterised by a smooth curve with varying curvature. The curve may be adjusted to achieve specific moving range.

[0190] In some embodiments, the resection module comprises about 2 to about 16 discs. In other embodiments, the resection module comprises about 2 to about 15 discs, about 2 to about 14 discs, about 2 to about 13 discs, about 2 to about 12 discs, about 2 to about 11 discs, about 2 to about 10 discs, about 2 to about 9 discs, about 2 to about 8 discs, about 3 to about 16 discs, about 3 to about 15 discs, about 3 to about 14 discs, about 3 to about 13 discs, about 3 to about12 discs, about 3 to about 11 discs, about 3 to about 10 discs, about 3 to about 9 discs, about 3 to about 8 discs, about 4 to about 16 discs, about 4 to about 15 discs, about 4 to about 14 discs, about 4 to about 13 discs, about 4 to about 12 discs, about 4 to about 11 discs, about 4 to about 10 discs, about 4 to about 9 discs, or about 4 to about 8 discs. In some embodiments, the resection module comprises about 4 to about 8 discs. In some embodiments, the resection module comprises about 6 to about 10 discs. In other embodiments, the resection module comprises about 6 to about 9 discs, about 6 to about 8 discs, about 7 to about 10 discs, about 7 to about 9 discs, or about 8 to about 10 discs. In some embodiments, the resection module comprises about 2 to about 6 discs. In other embodiments, the resection module comprises about 2 to about 5 discs, about 2 to about 4 discs, about 3 to about 6 discs, about 3 to about 5 discs, or about 4 to about 6 discs.

[0191] In some embodiments, the resection module comprises 8 discs. In some embodiments, the resection module comprises 4 discs. The disc may form a stack in the resection module. The resection module may comprise a plurality of stacked discs. Each stacked disc may be for actuating respective end-effector. Each stacked discs may be actuated by respective tendons. The plurality of stacked discs may be connected in series and formed a single continuum wrist. This allows for an increase in manoeuvrability. For example, the first stack of disc may bend to left and second stack of disc may bend to right, forming a S shape arm. In some embodiments, the tendon is a wire rope or super-elastic wire. The wire rope may be at least two metal wires twisted into a helix to form a composite metal rope. The tendon may be contained in a tendon sheath. The wire rope may act as a tendon in a tendon-sheath mechanism and may aid in the actuation of the as shown in FIG. 27D.

[0192] In a tendon- sheath mechanism comprising a sheath and a tendon, the sheath may be a hollow helical coil and the tendon may be a flexible cable or wire rope. When the wire ropeis pulled, it may slide inside the sheath and due to its displacement, transmit motion and force through the arm, acting as a tendon. The wire rope may be a stainless-steel wire rope.

[0193] In some embodiments, the tendon is characterised by an outer diameter of about 0.1 mm to about 0.5 mm. In other embodiments, the outer diameter is about 0.1 mm to 0.4 mm, about 0.1 mm to 0.3 mm, about 0.1 mm to 0.2 mm, about 0.2 mm to 0.5 mm, about 0.2 mm to 0.4 mm, or about 0.2 mm to 0.3 mm. In some embodiments, the tendon is characterised by an outer diameter of about 0.2 mm.

[0194] In some embodiments, the tendon is characterised by a breaking strength of about 20 N to about 200 N. In other embodiments, the breaking strength is about 20 N to about 180 N, about 20 N to about 160 N, about 20 N to about 140 N, about 20 N to about 120 N, about 20 N to about 100 N, about 20 N to about 80 N, about 20 N to about 60 N, about 40 N to about 200 N, about 40 N to about 180 N, about 40 N to about 160 N, about 40 N to about 140 N, about 40 N to about 120 N, about 40 N to about 100 N, about 40 N to about 80 N, or about 40 N to about 60 N.

[0195] In some embodiments, the tendon is characterised by a breaking strength of about 56 N. In some embodiments, the at least three tendons are contained within at least one sheath, or within three sheaths. This may form a tendon-sheath mechanism which actuates the endeffector. The tendon-sheath mechanism allows for load transmission from a motor to an endeffector, allowing the end-effector to maintain the force magnitude at the desired direction. The end-effector may be at the distal end of the first resection module, the end-effector configured to grip a tumour or the distal end of the second resection module, the end-effector configured to ablate a tumour. The sheath may be a rigid sheath. While this limits the degree of freedom of the first and second arms, manual control of the arms is made more consistent.

[0196] In some embodiments, the end-effector is characterised by an outer diameter of about 1 mm to about 5 mm. In other embodiments, the outer diameter is about 1 mm to about 4 mm,about 1 mm to about 3 mm, about 2 mm to about 5 mm, about 2 mm to about 4 mm, or about 2 mm to about 3 mm.

[0197] In some embodiments, the end-effector is characterised by an outer diameter of about 2.4 mm. In some embodiments, the end-effector is selected from a gripper, a coagulation gripper, a cutter, a snare, a retraction tool and a scissor. The cutter may have a tip of various shapes, which may be a loop, ball, triangle, point tip, and bended point tip (hook). Accordingly, various resection modules may be modularly combined to form a resectoscope suitable for a desired operation. For example, the surgeon may select a first resection module having a gripper member and a second resection module having a cutter member. This combination may be suitable for resecting a tumour in a bladder (FIG. 2).

[0198] In some embodiments, the resection module further comprises an actuation means in communication with the end-effector. In some embodiments, the actuation means is in communication with the end-effector via the at least three tendons. The actuation means may comprise a tendon-sheath mechanism which may allow an arm (end-effector) to maintain the force magnitude at the desired direction. The end-effector may be the distal end of the arm configured to grip a tumour or the distal end of the second arm configured to ablate a tumour.

[0199] The actuator means actuate the end-effector by means of the tendons. In some embodiments, the end-effector is characterised by at least three degrees of freedom. The tendons may control three degrees of freedom such as pitch, yaw and gripping. The at least three tendons may actuate in combination to provide the at least three degrees of freedom. In some embodiments, the end-effector is characterised by at least five degrees of freedom. Depending on the type of arm, the degree of freedom may be different. For example, if the endeffector is a gripper, the five degrees of freedom that the arm may consists of translational, roll, pitch (up / down), yaw (left / right) and a gripping (open / close) degree of freedom. If the endeffector is a cutter, the five degrees of freedom that the aim may consists of translational, roll.pitch, yaw and a rotation (triangulation). The pitch and yaw degree of freedoms may be achieved by the plurality of discs and at least one tendon passing through the plurality of discs in each arm. This may prevent snapping motion of the arms when in use. The degrees of freedoms provide dexterity needed to allow the surgeon to control the instruments and also maintain a payload large enough to perform en-bloc tumour resection.

[0200] In some embodiments, the at least one tendon passes through a side hole of the plurality of discs, wherein one end of the tendon is connected to the end-effector and the other end connected to an actuation means for pulling or releasing the tendon. When tendon is pulled, the curved discs roll over each other, resulting in a shift of the line of contacts, forming the bent pose. The line of contact shifts along the single curve and becomes aligned with the direction that has zero curvature without intersecting the longitudinal axis. Different tendons may control different aspects of the various degrees of freedom such as the up and down motion (pitch), the left and right motion (yaw) and the opening and closing motion (gripping). Multiple tendons may be needed to control a degree of freedom. This may be configured depending on the type of member at the end-effector.

[0201] In some embodiments, the end-effector is characterised by a rotational roll angle of 0° to about 180°. In other embodiments, the angle is 0° to about 150°, 0° to about 120°, or 0° to about 90°. In some embodiments, the angle is 0°. In some embodiments, the angle is about 180°.

[0202] In some embodiments, the end-effector is characterised by a translational motion along a longitudinal axis of the arm of 0 mm to about 60 mm. In other embodiments, the translational motion is 0 mm to about 60 mm, 0 mm to about 50 mm, or 0 mm to about 40 mm. In some embodiments, the translation motion is about 40 mm.

[0203] In some embodiments, the end-effector is characterised by a pitch angle of about +90° to about -90°. In other embodiments, the angle is about +90° to about -70°, about +90° to about -50°, about +90° to about -30°, about +90° to about -10°, about +70° to about -90°, about+70° to about -70°, about +70° to about -50°, about +70° to about -30°, about +70° to about -10° , about +50° to about -90°, about +50° to about -70°, about +50° to about -50°, about +50° to about -30°, about +50° to about -10°, about +30° to about -90°, about +30° to about -70°, about +30° to about -50°, about +30° to about -30°, about +30° to about -10°, about +10° to about - 90°, about +10° to about -70°, about +10° to about -50°, about +10° to about -30°, about +10° to about -10°, 0° to about -90°, 0° to about -70°, 0° to about -50°, 0° to about -30°, 0° to about -10°, about +90° to 0°, about +90° to about +10°, about +90° to about +30°, about +90° to about +50°, about +90° to about +70°, about +70° to 0°, about +70° to about +10°, about +70° to about +30°, about +70° to about +50°, about +50° to 0°, about +50° to about +10°, about +50° to about +30°, about +30° to 0°, about +30° to about +10°, or about +10° to 0°. In some embodiments, the angle is 0°. Tn some embodiments, the angle is about 40°. In some embodiments, the angle is 0° to about 40°.

[0204] In some embodiments, the end-effector is characterised by a yaw angle of about +90° to about -90°. In other embodiments, the angle is about +90° to about -70°, about +90° to about -50°, about +90° to about -30°, about +90° to about -10°, about +70° to about -90°, about +70° to about -70°, about +70° to about -50°, about +70° to about -30°, about +70° to about -10°, about +50° to about -90°, about +50° to about -70°, about +50° to about -50°, about +50° to about -30°, about +50° to about -10°, about +30° to about -90°, about +30° to about -70°, about +30° to about -50°, about +30° to about -30°, about +30° to about -10°, about +10° to about - 90°, about +10° to about -70°, about +10° to about -50°, about +10° to about -30°, about +10° to about -10°, 0° to about -90", 0" to about -70°, 0° to about -50°, 0° to about -30°, 0° to about -10°, about +90° to 0°, about +90° to about +10°, about +90° to about +30°, about +90° to about +50°, about +90° to about +70°, about +70° to 0°, about +70° to about +10°, about 35 +70° to about +30°, about +70° to about +50°, about +50° to 0°, about +50° to about +10°, about +50° to about +30°, about +30° to 0°, about +30° to about +10°, or about +10° to 0°. In some embodiments.the angle is 0°. In some embodiments, the angle is about 40°. In some embodiments, the angle is 0° to about 40°. In some embodiments, the angle is 0° to about +90°. In some embodiments, the angle is 0° to about -90°.

[0205] In some embodiments, the end-effector is characterised by a gripping angle of 0° to about 90°. In other embodiments, the angle is 0° to about 80°, 0° to about 70°, 0° to about 60°, 0° to about 50°, or 0° to about 45u. In some embodiments, the angle is 0°. In some embodiments, the angle is about 90°. In some embodiments, the angle is about 0° to about 30°. In some embodiments, the angle is 0° to about 90°. In some embodiments, the end-effector is characterised by a rotation motion of about +180° to about -180°. In other embodiments, the angle is about +180° to about -120°, about +180° to about -90°, about +180° to about -30°, about + 180° to 0°, about +180° to about +30°, about +180° to about +90u, about +180uto about +120°, about +120° to about +180°, about +120° to about -120°, about +120° to about -90°, about +120° to about -30°, about +120° to 0°, about +120° to about +30°, about +120° to about +90°, about +90° to about +180°, about +90° to about -120°, about +90° to about -90°, about +90° to about -30°, about +90° to 0°, about +90° to about +30°, about +30° to about +180°, about +30° to about -120°, about +30° to about -90u, about +30° to about -30°, about +30° to 0u, 0° to about -180°, 0° to about -120°, 0° to about -90°, 0° to about -30°, about -30° to -180°, about -30° to about - 120°, about -30° to about -90°, about -90o to about -180°, about -90° to about -120°, or about - 120° to about -180°

[0206] In some embodiments, the angle is 0°. In some embodiments, the angle is about 30°. In some embodiments, the angle is 0° to about 30°. The rotation may be actuated by a torque coil, which is disclosed in further detail below. In some embodiments, the end-effector is characterised by a force of about 20 N at the tendon. The force applied at the tendon may transmit through the end-effector, providing a gripping force for the end-effector. The force may be applied to the tendon near the actuation system.[00207 J In some embodiments, the end-effector is characterised by a wrist force of less than about 0.48 N. A wrist force is related with the continuum wrist and is the force of the wrist on an object which the distal end of the arm is in contact with. To achieve same wrist force, the force applied at the tendon may vary when the tendon-sheath mechanism's shape changes. In other embodiments, the force is less than about 0.45 N, about 0.4 N, about 0.35 N, about 0.3 N, about 0.25 N, about 0.2 N, about 0.15 N, or about 0.1 N.

[0208] In some embodiments, the end-effector is characterised by a gripping force of less than about 10 N. A gripping force is the force exerted by a gripper type end-effector at the distal end of the arm to a target. In other embodiments, the force is less than about 9N, about 8 N, about 7 N, about 6 N, about 5 N, about 4 N, about 3 N, about 2 N, about 1 N, about 0.8 N, about 0.5 N or about 0.3 N.

[0209] In some embodiments, the end-effector is characterised by a gripping force of less than about 5 N. In some embodiments, the end-effector is characterised by a gripping force of about 0.7 N when the arm is parallel to the longitudinal axis of the device. In some embodiments, when the end-effector is a cutter, the cutter is an electrocautery means or a laser cauterisation means. The cutter may have a triangular tip (FIG. 15 A), a hook tip (FIG. 15B) or a straight tip (FIG. 15C). Electrocautery refers to a process in which a direct or alternating current is passed through a resistant metal wire electrode, generating heat. The heated electrode is then applied to living tissue to achieve hemostasis or varying degrees of tissue destruction. For example, when the tumour is lifted by a gripper arm to expose the base of the tumour, a second arm with electrocautery means may be introduced to dissect through the base of the tumour including a muscle layer (FIGs. 4A to 4D). The position of the resection device may be adjusted if the tumour size is large and the tumour resection may be continued further underneath the tumour until the entire tumour is resected in one piece. Laser cauterisation refers to a process in which a laser beam is used to cut tissue.

[0210] In some embodiments, the electrocautery means is an electrocautery knife. In some embodiments, the resection module further comprises an elongated member adjacent to a proximal end of the end-effector. The elongated member acts as a base for supporting the endeffector. The elongated member may be configured to provide additional degrees of movement to the end-effector. For example, an end of the elongated member adjacent to the discs may have a semi -spheric al morphology. The elongated member may be a rigid hollow member. For example, stainless steel may be used. The elongated member may be connected to a torque coil at the other end thereof. Tire torque coil is a flexible coil, which transmits torque control from its distal end thereof to the arm. In this regard, the tendons run from the arm to the distal end of the torque coil. The actuation means may thus be coupled to the tendons as they exit the distal end of the torque coil. For example, FIG. 35 shows a resection module comprising the arm, an elongated member at the proximal end of the arm and a torque coil connected to the elongated member.

[0211] The elongated member and the torque coil may have a same diameter and be continuous from one end to another end. Alternatively, the elongated member may have a small diameter while the torque coil has a bigger diameter. When the torque coil is sized to be larger, the elongated member may connect with the torque coil by at least partially passing into a section of the torque coil.

[0212] The elongated member may be contained in a housing or guide (or instrument adaptor), such that the arm is exposed at one end thereof and the torque coil is exposed at the other end thereof. The housing may be sized such that it may further house an endoscope. The housing may be fabricated by 3D printing and assembled using stainless steel tubes. In other embodiments, the housing is casted, injection molded or computer numerical control (CNC) machined. The housing allows for ease of insertion into an irrigation sheath, and may be furthercontained within an irrigation sheath. The housing may be further contained within an inner irrigation sheath and an outer irrigation sheath.

[0213] As shown in FIG. 34, the instrument adaptor may be inserted into the irrigation sheaths, forming an irrigation sheath assembly. The irrigation sheaths may provide proper water circulation to ensure safe pressure at the operation site, such as inside the bladder, and clear' vision during operation of the device. The above setup allows the resectoscope to be detached from the actuation means, which is usually heavy. As shown in FIG. 33, the resection module (or instrument) may be inserted into the irrigation sheath assembly, forming a resectoscope. This allows for easy movement of the resectoscope by the surgeon.

[0214] The present disclosure also concerns a resectoscope comprising a resection module as disclosed herein. In some embodiments, the resectoscope comprises a resection module, the resection module comprising: a) an end-effector at an end of the resection module thereof; b) a plurality of discs having at least a curved surface, the end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the end-effector.

[0215] In some embodiments, the resectoscope comprises at least two resection modules, a first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first endeffector; and a second resection module comprising: d) a second end-effector at an end of the resection module thereof, the second end-effector is a cutter; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs; and f) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the second end-effector.

[0216] In some embodiments, the resectoscope comprises at least two resection modules, a first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first endeffector; and a second resection module comprising: d) a second end-effector at an end of the resection module thereof, the second end-effector is a snare; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs; and f) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the second end-effector. In some embodiments, the resectoscope comprises at least two resection modules, a first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first end-effector; and a second resection module comprising: d) a second endeffector at an end of the resection module thereof, the second end-effector is a scissor; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs; and f) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the second end-effector.

[0217] In some embodiments, the resectoscope comprises at least two resection modules, a first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first endeffector; and a second resection module comprising: d) a second end-effector at an end of theresection module thereof, the second end effector is a coagulation gripper; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs ; and f) at least three tendons passing through the plurality of discs and coupled to the endeffector for actuating the second end-effector.

[0218] In some embodiments, the resectoscope comprises at least two resection modules, a

[0219] first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a coagulation gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first end-effector; and a second resection module comprising: d) a second endeffector at an end of the resection module thereof, the second end-effector is a cutter; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs; and f) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the second end-effector.

[0220] In some embodiments, the resectoscope comprises at least two resection modules, a first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a coagulation gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first end-effector; and a second resection module comprising: d) a second end-effector at an end of the resection module thereof, the second end-effector is a snare; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs ; and f) at least three tendons passing through the plurality of discs and coupled to the endeffector for actuating the second end-effector.[00221 J In some embodiments, the resectoscope comprises at least two resection modules, a first resection module comprising: a) a first end-effector at an end of the resection module thereof, the first end-effector is a coagulation gripper; b) a plurality of discs having at least a curved surface, the first end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the first end-effector; and a second resection module comprising: d) a second end-effector at an end of the resection module thereof, the second end-effector is a scissor; e) a plurality of discs having at least a curved surface, the second end-effector movably coupled to the plurality of discs; and f) at least three tendons passing through the plurality of discs and coupled to the endeffector for actuating the second arm end-effector.

[0222] In some embodiments, the first resection module comprises a first elongated member and a first torque coil and second resection module comprises a second elongated member and a second torque coil. In some embodiments, the first resection module and second resection module arc housed within a housing such that the first end-effector and second end-effector extends out from an end of the housing thereof and the first torque coil and second torque coil extends out from another end of the housing thereof.

[0223] In some embodiments, the resectoscope comprises at least three resection modules, each resection module comprising: a) an end-effector at an end of the resection module thereof; b) a plurality of discs having at least a curved surface, the end-effector movably coupled to the plurality of discs; and c) at least three tendons passing through the plurality of discs and coupled to the end-effector for actuating the end-effector. The resection modules are in collaboration with each other. Each end-effector of the respective resection modules is selected from a gripper, a coagulation gripper, a cutter, a snare, a retraction tool and a scissor.

[0224] In some embodiments, each of the at least three resection modules comprises an elongated member and a torque coil. In some embodiments, the at least three resection modulesare housed within a housing such that the at least three end-effectors extend out from an end of the housing thereof and the at least three torque coils extend out from another end of the housing.

[0225] In some embodiments, the housing is further contained within an irrigation sheath and an outer irrigation sheath. In some embodiments, the outer sheath is characterised by an outer diameter of about 6 mm to about 9.3 mm. In other embodiments, the diameter is about 6 mm to about 9 mm, about 7 mm to about 9.3 mm, or about 7 mm to about 9 mm. In some embodiments, the outer sheath is characterised by an outer diameter of about 8.7 mm. In some embodiments, the inner sheath is characterised an outer diameter of about 5 mm to about 8 mm. In other embodiments, the diameter is about 5 mm to about 7 mm, about 6 mm to about 8 mm, or about 6 mm to about 7 mm. In some embodiments, the inner sheath is characterised by an outer diameter of about 7 mm.

[0226] The present disclosure also concerns a method of removing tumour with a rcscctoscopc as disclosed herein, comprising: a) actuating the first end-effector in order to grip the tumour; and b) actuating the second end-effector in order to ablate the tumour; wherein the step of actuating the first and second end-effectors comprises relative displacement and rotation of the plurality of discs having at least a curved surface over each other.

[0227] In some embodiments, the method of removing tumour with a resectoscope as disclosed herein comprises: a) actuating the first end-effector in order to grip the tumour; b) actuating the second end-effector in order to ablate the tumour; and c) actuating at least a third end-effector in order to cut, hold, or retrieve the tumour; wherein the step of actuating the endeffectors comprises relative displacement and rotation of the plurality of discs having at least a curved surface over each other. The end-effectors are in collaboration with each other and the additional at least third arm may be controlled by another operator.[00228J The resectoscope may be inserted into a natural orifice of the human body. The resection module or resectoscope is positioned near the tumour and the first and second endeffectors are extended towards the tumour. The surgeon may use the first end-effector to grip and lift the tissue, then used the electrocautery knife (second end-effector) to make incisions and remove the grasped tissue. When the resection is completed, both the first and second endeffectors are returned to a straight position and removed from the human body.

[0229] All examples described herein, whether of methods, materials, or products, are presented for the purpose of illustration and to aid understanding and are not intended to be limiting or exhaustive. Modifications may be made by one of ordinary skill in the art without departing from the scope of the invention as claimed.

Claims

CLAIMS1. A transurethral resection device, comprising: a housing defining a channel, the channel extending along an axial direction; a grasper assembly disposed in the channel, the grasper assembly being movable relative to the channel along the axial direction, the grasper assembly including: a grasper defining a tip of the grasper assembly; a first elongated body defining a grasper body axis parallel to the axial direction; and a first continuum joint coupled between the first elongated body and the grasper, the first continuum joint being actuatable to displace the grasper relative to the first elongated body; and a cutter assembly disposed in the channel, the cutter assembly being movable relative to the channel along the axial direction, the cutter assembly including: a cutter defining a tip of the cutter assembly; a second elongated body defining a cutter body axis parallel to the axial direction; and a second continuum joint coupled between the second elongated body and the cutter, the second continuum joint being actuatable to displace the cutter in relative to the second elongated body, wherein the first continuum joint and the second continuum joint are actuatable independently of one another.

2. The transurethral resection device as recited in claim 1, wherein the grasper assembly is actuatable to vary a first pose of the grasper, the first pose comprising a first orientation and a first location of the grasper relative to the housing, and wherein the cutter assembly is actuatable to vary a second pose of the cutter, the second pose comprising a second orientation and a second location of the cutter relative to the housing.

3. The transurethral resection device as recited in any one of the above claims, wherein the first continuum joint is actuatable to move the grasper along a grasper plane, and wherein the second continuum joint is actuatable to move the cutter in a cutter plane, the cutter plane being orthogonal to the grasper plane.

4. The transurethral resection device as recited in claim 3, wherein the second continuum joint is actuatable to displace the cutter along a sweeping path in the cutter plane.

5. The transurethral resection device as recited in claim 4, wherein the second continuum joint is actuatable to displace the cutter along the sweeping path periodically.

6. The transurethral resection device as recited in any one of the above claims, wherein the first continuum joint is actuatable to move the grasper within a grasper angular displacement range, and wherein the second continuum joint is actuatable to move the cutter within a cutter angular displacement range, and wherein the grasper angular displacement range is larger than the cutter angular displacement range.

7. The transurethral resection device as recited in any one of the above claims, wherein each of the first continuum joint and the second continuum joint is bendable about respective two orthogonal axes.

8. The transurethral resection device as recited in any one of the above claims, wherein the first continuum joint is actuatable to move the grasper away from the cutter body axis, and wherein the first continuum joint is actuatable to move the grasper towards the cutter body axis.

9. The transurethral resection device as recited in any one of the above claims, wherein the second continuum joint is actuatable to move the cutter away from the grasper body axis, and wherein the second continuum joint is actuatable to move the cutter towards the grasper body axis.

10. The transurethral resection device as recited in any one of the above claims, wherein the grasper assembly is rotatable about the grasper body axis, and wherein the cutter assembly is rotatable about the cutter body axis.

11. The transurethral resection device as recited in any one of the above claims, further comprising an endoscope disposed in the channel, the endoscope being positioned adjacent to the grasper assembly and the cutter assembly.

12. The transurethral resection device as recited in claim 11, wherein the endoscope defines an endoscope body axis, wherein the endoscope body axis, the grasper body axis and the cutter body axis are radially spaced apart about the axial direction.

13. The transurethral resection device as recited in any one of claims 9 and 10, wherein the grasper and the cutter are disposed within a field of view of the endoscope.

14. The transurethral resection device as recited in any one of the above claims, further comprising a swivel joint coupled between the second elongated body and the second continuum joint, wherein the swivel joint is rotatable about a swivel axis to collectively move the cutter and the second continuum joint relative to the second elongated body.

15. The transurethral resection device as recited in any one of the above claims, wherein the grasper is any one selected from: a jaw gripper, a coagulation gripper, an electrocautery forceps, a snare, and a loop.

16. The transurethral resection device as recited in any one of the above claims, wherein the cutter is any one selected from: an electrocautery cutter, an electro cautery forceps, an ultrasonic blade, a surgical laser device and a scissor.

17. The transurethral resection device as recited in any one of the above claims, wherein the grasper body axis is spaced apart from and parallel to the cutter body axis.

18. The transurethral resection device as recited in any one of the above claims, wherein each of the first continuum joint and the second continuum joint comprises: a plurality of discs stacked in contact along the axial direction; and a plurality of tendons passing through each of the plurality of discs, wherein each of the plurality of discs defines a respective disc axis,wherein each of the plurality of discs comprises a first curved surface and an opposing second curved surface, wherein the first curved surface defines a first ridge and the second curved surface defines a second ridge, the first curved surface and the second curved surface being configured to define an angle between the first ridge and the second ridge.

19. The transurethral resection device as recited in claim 18, wherein for each of the plurality of discs, each of the first ridge and the second ridge being orthogonal to one another and to the respective disc axis.

20. The transurethral resection device as recited in any one of claims 18 and 19, wherein each of the plurality of discs comprises: a plurality of first through holes aligned with the first ridge; and a plurality of second through holes aligned with the second ridge, wherein each of the plurality of tendons is tensionable and threaded through a respective one of: the plurality of first through holes and the plurality of second through holes.

21. The transurethral resection device as recited in any one of claims 18 to 20, wherein each of the plurality of discs forms a respective line contact with an adjacent one of the plurality discs.

22. The transurethral resection device as recited in any one of claims 18 to 21, wherein selected ones of the respective line contact shifts in response to a change in a tension in at least one of the plurality of tendons.

23. The transurethral resection device as recited in any one of the above claims, wherein the housing maintains a relative orientation between the first elongated body and the second elongated body.

24. The transurethral resection device as recited in any one of the above claims, wherein the housing defines a maximum diametrical dimension of 7 millimetres.

25. A transurethral resection system, comprising: an irrigation sheath defining a device channel, the irrigation sheath comprising an irrigation inlet path and an irrigation outlet path; and the transurethral resection device as recited in any one of the above claims, the transurethral resection device fluid seahngly coupled to the device channel.

26. The transurethral resection system as recited in claim 25, further comprising an actuator operably coupled to the transurethral resection device, wherein the actuator is a tendon tensioner being configured to actuate the grasper assembly and the cutter assembly.

27. The transurethral resection system as recited in claim 26, further comprising a controller in signal communication with the actuator, wherein the controller controls the actuator to actuate the transurethral resection device.

28. The transurethral resection system as recited in claim 27, further comprising a user interface in signal communication with the controller, the user interface being configured to receive control commands from a user.

29. The transurethral resection system as recited in any one of claims 25 to 28, being configured to perform a method of: gripping a target portion disposed on a target surface with the grasper; while holding onto the target portion using the grasper, moving the grasper away from the target surface along a grasper plane; and moving the cutter in a cutter plane to cut between the target portion and the target surface, wherein the cutter plane is orthogonal to the grasper plane.

30. A method of operating the transurethral resection device as recited in any one claims 1 to 24, the method comprising: gripping a target portion disposed on the target surface with the grasper; while holding onto the target portion using the grasper, moving the grasper away away from the target surface along a grasper plane; and moving the cutter in a cutter plane to cut between the target portion and the target surface, wherein the cutter plane is orthogonal to the grasper plane.

Images