Mainland China's First MONARCH Robot Officially Settles at Shanghai General Hospital, Bringing Incision-Free Precise Lung Cancer Treatment

Background

Lung cancer is described in reports as the leading cause of cancer incidence and mortality in China and worldwide. Many patients are diagnosed at advanced stages. Widespread CT screening has increased detection of pulmonary nodules, including multiple pulmonary nodules. Sources report the proportion of multiple pulmonary nodules in China ranges from 13.26% to 45.56%. These nodules are often small, dispersed, and located in peripheral lung areas.

Traditional approaches to diagnosing peripheral lesions can be limited. Manual navigation bronchoscopy may struggle to reach distal targets precisely. Percutaneous puncture approaches carry reported risks including bleeding and pneumothorax. The MONARCH platform, a natural-orifice robotic system developed by Johnson & Johnson MedTech, was introduced to enable transbronchial access without skin incisions.

What was achieved

On July 17, 2025, mainland China's first MONARCH robotic system was officially placed into clinical service at Shanghai General Hospital (also known as Shanghai Jiao Tong University School of Medicine Affiliated First People's Hospital) in its thoracic surgery department. This marked the formal launch following earlier trial use.

Hospital President Zheng Xingdong stated that in September of the previous year, the hospital completed Shanghai's first MONARCH robot-assisted incision-free localization procedure. The case involved a patient with a 10 mm high-risk ground-glass nodule. The robot enabled precise localization without percutaneous puncture, followed by successful sublobar resection. Zheng noted that official deployment of the MONARCH platform would allow the digitized innovative technology to serve more patients and support early lung cancer screening and treatment.

Professor Fan Jiang, director of thoracic surgery at the hospital, indicated that application of the natural-orifice robotic technology expands surgical concepts and technical systems for early diagnosis and treatment of lung cancer. He reported that after nearly one year of clinical application since initial landing, the team had built a relatively mature foundation for exploration and standardized use.

How it works

The MONARCH system is a robotic platform for minimally invasive, precise diagnosis and treatment of lung cancer and pulmonary nodules via the body's natural airways. A flexible bronchoscope is introduced through the patient's mouth or nose into the trachea and advanced through the bronchial tree. Doctors control the system using a game-style handle that operates dual robotic arms.

These arms replace manual bronchoscope manipulation, offering flexibility and precision reported to reach sub-millimeter displacement accuracy. The platform integrates multimodal fusion navigation combining optical recognition, dynamic electromagnetic guidance, and scope motion tracking. This enables the bronchoscope to reach small peripheral airways and deep distal lesions under continuous real-time visualization.

Once positioned, the system supports precise biopsy sampling or lesion localization for subsequent procedures. The entire process occurs without incisions on the body surface, providing an integrated pathway described as 'no-incision diagnosis - precise localization - minimally invasive treatment.' Sources note it facilitates access to areas difficult for traditional techniques while aiming to reduce certain complication risks associated with chest wall puncture.

What it means for international patients

Shanghai General Hospital operates an International Medical Care Center (also referred to as International Medical Healthcare Center or IMCC) that provides services to international and foreign patients. The center, established in the early 1990s with predecessors dating to the 1950s-1960s, offers dedicated facilities, bilingual Chinese-English support, VIP areas, one-stop appointment services, and direct billing arrangements with various international commercial insurers.

International patients interested in evaluation of pulmonary nodules or early lung cancer diagnostics and treatment involving advanced robotic technology at this hospital can inquire about the MONARCH system's availability. Eligibility for specific procedures depends on individual medical assessment. Patients should contact the hospital's International Medical Center directly to confirm current capabilities, discuss suitability with the thoracic surgery team, and obtain personalized information on access and care pathways.

About the hospital

Shanghai General Hospital, founded in 1864 by French consuls, is one of the earliest and largest Western medicine hospitals established in China. It was renamed Shanghai Municipal First People's Hospital in 1953 and became affiliated with Shanghai Jiao Tong University School of Medicine in 2002. It is classified as a Class A tertiary general hospital.

The hospital operates two campuses: the North Campus in Hongkou District (Haining Road) and the South Campus in Songjiang District (New Songjiang Road). It occupies a large land area reported as the biggest among Shanghai hospitals at the time of some reports, with approximately 2,580 beds and over 4,000 staff members. It provides comprehensive services across numerous clinical departments and has maintained an active thoracic surgery department.

Known clinical focuses include ophthalmology, urology, nephrology, geriatrics, endocrinology, and cardiology, among others. The hospital's International Medical Care Center serves as a designated facility for international medical services, supporting outpatient, inpatient, health examinations, and emergency care for overseas patients.