Picasso Digestive Endoscopic Surgical Robot

Picasso, developed by ROBO Medical in collaboration with Qilu Hospital of Shandong University, became the first digestive endoscopic surgical robot to receive NMPA approval in China when it cleared regulatory review in March 2025. The system assists gastroenterologists performing endoscopic submucosal dissection (ESD) for early-stage gastrointestinal cancers.

Product Overview

Picasso addresses a critical gap in surgical robotics: the lack of robotic assistance for procedures performed through natural orifices. While laparoscopic and orthopedic surgical robots have achieved significant market penetration, endoluminal surgery has remained largely unassisted by robotic technology due to the technical challenges of navigating flexible instruments through the gastrointestinal tract.

The system is designed around a single-arm flexible architecture—making it the world’s first commercially approved single-arm flexible gastrointestinal surgical robot. Rather than replacing traditional endoscopes, Picasso works alongside them, adding robotic precision to ESD procedures without requiring hospitals to abandon existing equipment.

Key Features

At under 3 mm diameter, Picasso’s continuum robotic arm passes through standard endoscope channels with 6 degrees of freedom for NMPA-approved ESD procedures.

• Miniature Flexible Robotic Arm: The continuum robot design achieves a diameter under 3mm, enabling passage through standard endoscope working channels
• 6 Degrees of Freedom: Full articulation provides the dexterity needed for precise tissue manipulation in confined GI tract spaces
• Master-Slave Control: Surgeon movements at the console translate directly to robotic actions at the surgical site
• Endoscope Compatibility: Works with existing endoscopic infrastructure without requiring modifications to traditional equipment
• Intuitive Operation: Robotic arm movements replace traditional endoscope manipulation, making the procedure feel more natural to surgeons

Technical Specifications

At 3 mm arm diameter and 6 DOF, Picasso operates via master-slave teleoperation through standard digestive endoscopes for endoscopic submucosal dissection.

Clinical Applications

Picasso is specifically designed for endoscopic submucosal dissection (ESD), a minimally invasive technique for removing early-stage tumors from the gastrointestinal tract lining. ESD offers significant advantages over traditional surgery—no external incisions, faster recovery, and preservation of organ function.

Target conditions include:

• Early gastric cancer
• Early esophageal cancer
• Early colorectal cancer
• Large gastrointestinal polyps
• Submucosal tumors

The clinical challenge that Picasso addresses is significant: ESD requires exceptional manual dexterity, and in China only several hundred physicians are qualified to perform the procedure despite annual demand exceeding 500,000 cases. By providing robotic assistance, the system aims to lower the technical barrier and reduce complication rates.

Clinical data from registration trials indicated potential benefits in reducing bleeding and perforation rates—the two most common ESD complications.

Regulatory Status

Picasso completed multi-center, prospective, parallel-controlled NMPA registration clinical trials initiated in May 2022. The trials evaluated efficacy and safety in ESD procedures across multiple hospital sites.

Competitive Landscape

The digestive endoscopic surgical robot segment remains nascent globally. Major international players including Johnson & Johnson (Monarch platform) and Intuitive Surgical (Ion system) have focused on bronchoscopy applications rather than gastrointestinal ESD.

Within China, companies including Qiaojieli Medical (巧捷力医疗) and Lanhe Medical (朗合医疗) are developing competing endoluminal platforms, though Picasso achieved first-to-market status with its March 2025 NMPA approval.

Olympus, the dominant player in digestive endoscopy, announced in 2025 a joint venture to develop endoluminal surgical robots targeting gastrointestinal applications, suggesting growing industry recognition of this market opportunity.

Frequently Asked Questions

What procedures can Picasso perform?

Picasso is designed specifically for endoscopic submucosal dissection (ESD), a procedure used to remove early-stage cancers and large polyps from the gastrointestinal tract, including the stomach, esophagus, and colon.

How is Picasso different from laparoscopic surgical robots?

Unlike laparoscopic robots (such as da Vinci) that operate through small incisions in the abdomen, Picasso works through natural orifices using flexible instruments that navigate through the GI tract. It features a miniaturized flexible arm under 3mm diameter rather than rigid robotic arms.

Is Picasso approved for clinical use?

Yes, Picasso received NMPA approval in China in March 2025, making it the first approved digestive endoscopic surgical robot in the country. International regulatory status (CE Mark, FDA clearance) has not been publicly announced.

Does Picasso replace traditional endoscopes?

No, Picasso is designed to work alongside existing endoscopic equipment. The system maintains compatibility with standard digestive endoscopes without requiring modifications, which helps lower adoption barriers for hospitals.