A robot to enable broad deployment of the least invasive uterine fibroid surgical intervention

The National Institute of Biomedical Imaging and Bioengineering awarded Virtuoso Surgical, Inc. $1,094,485 on September 1, 2026, under the Discovery and Applied Research for Technological Innovations to Improve Human Health program (CFDA 93.286) to develop a surgical robot enabling minimally invasive hysteroscopic removal of uterine fibroids.

The robot delivers two miniature robotic instruments through a standard clinical hysteroscope, enhancing surgical dexterity and enabling two-handed maneuvers including simultaneous independent tissue retraction and cutting. The needle-sized instruments bend and elongate like tentacles through telescoping, curved, elastic tubes that axially rotate and extend independently, allowing controlled bending and elongation to facilitate intrauterine surgery in small spaces. By decoupling visualization from tool movement and providing dexterity, the technology aims to make minimally invasive hysteroscopic fibroid removal accessible beyond elite surgeons, addressing a clinical gap where approximately 90,000 women annually undergo hysterectomy for fibroids despite clinical evidence that many can be safely removed hysteroscopically.

The award is classified as a Project Grant. Work is performed in Nashville, Tennessee. The period of performance runs from September 1, 2026, through August 31, 2028.

Abstract

The objective of this proposal is to create a new surgical robot to enable minimally invasive removal of uterine fibroids. Over two-thirds of women will have fibroids in their lifetimes, and many will need surgical interventions. Hysterectomy (with many associated lifelong complications) is often the default, because today only elite SUR- geons can perform minimally invasive hysteroscopic fibroid removal, due to the difficulty of the procedure. Our robot will make the procedure far easier to perform, by delivering needle-sized instruments through a standard hysteroscope. This will enable independent tissue manipulation, retraction, and visualization to facilitate precise, accurate, and efficient intrauterine surgery. Clinical significance: fibroids are pervasive; nearly 90,000 women - each year - will lose their uterus to fibroids that the clinical literature shows can be removed safely and effectively hysteroscopically. There just are not enough elite surgeons to offer these procedures widely. Instrument dexterity limitations prevent typical surgeons from performing these procedures. Because of this, only 1 in 10 women are currently able to benefit from a minimally invasive hysteroscopic approach. Innovation: we deliver two miniature robotic instruments through a standard clinical hysteroscope, enhancing dexterity and enabling two-handed maneuvers including simultaneous independent retraction and cutting of TIS- SUE. Our needle-sized robots bend and elongate like tiny tentacles. They are made from telescoping, curved, elastic tubes. We axially rotate and telescopically extend each tube independently. The result is controllable bending and elongation that enables two-handed surgeries in small spaces in the uterus - delivered through a standard clinical endoscope transvaginally. By providing dexterity, decoupling visualization from tool movement, and enabling countertraction, our system makes these procedures much easier to perform, enabling surgeons to accurately and efficiently remove fibroids. Approach: in aim 1 we design, construct, and test a corkscrew instrument to securely manipulate and retract fibroids. In aim 2 we conduct formative and summative human factors evaluations to ensure system usability and safety. The purpose of aim 3 is experimental validation. These experiments will demonstrate resection of fibroids of various sizes from all relevant locations of the uterus in an EX-vivo model and cadaver model. The endpoint of this phase II project is full validation of our system in in cadavers, setting the stage for clinical translation and regulatory approval.