This article is from Arterial Network, written by Li Wenyun.

In the field of surgical robots, a dark horse—the bronchoscopy robot—has emerged. From approval to explosive growth, it took less than three years.

In March 2023, it received FDA approval in the United States. Since then, the number of surgeries has skyrocketed: 500 surgeries were performed in the US in 2023, exceeding 5,000 in March 2025, and surpassing 10,000 cases globally in March 2026. As of April 2026, the system has been installed at medical institutions in the US and Australia, including the University of Chicago Medical Center, Inova Fairfax Hospital, CHI Memorial, Macquarie University Hospital, and Long Island Jewish Medical Center.

Commercial progress has also been rapid. In April 2023, the company completed a $150 million (approximately RMB 1.024 billion) financing round, with leading institutions such as SoftBank Vision Fund, Prosperity7 Ventures, Tiger Global Management, Hillhouse Capital, and Sequoia China all participating.

Both the immediate ramp-up upon approval and the incredibly steep commercial growth curve are rare and truly "abnormal" in the global surgical robot field.

Looking at the global commercialization of surgical robots, laparoscopic robots, which cover multiple major departments such as general surgery, urology, gynecology, and thoracic surgery, should theoretically have a larger market space and faster growth. However, in reality, apart from a few giants like Intuitive Surgical, most latecomers are deeply mired in losses. On the contrary, this company, which focuses on the highly specialized field of interventional pulmonology, has made rapid progress in commercialization, turning a narrow door into a wide road.

In the vertical bronchoscopy robot market, Intuitive Surgical's Ion system had 995 units installed globally by the end of 2025, making it the largest bronchoscopy robot system in terms of publicly available data; Johnson & Johnson's Monarch has not yet disclosed its specific installation scale. Both benefited to varying degrees from their existing hospital networks, service systems, and brand accumulation during their promotion, and did not start entirely from scratch. In contrast, this startup and its product had no established ecosystem to rely on, yet it achieved rapid market penetration and breakthroughs by leveraging its technological advantages of "real-time image confirmation + all-disposable consumables + small size," becoming the current global robotic platform providing disposable bronchoscopes.

The study published in CHEST 2025 further corroborated the underlying logic of this “narrow gate outbreak”: in community hospitals outside of academic centers, the bronchoscopy robot still achieved a diagnostic output rate of 89%, and the cost-effectiveness ratios of the endoscopy room and the operating room were 1.5 and 1.1 respectively (greater than 1 is considered financially feasible) [1], proving that the bronchoscopy is both clinically feasible and economically sustainable in the community hospital environment.

This impressive product is named Galaxy, and the company behind it is Noah Medical, founded by Dr. Zhang Jian. Noah Medical is Dr. Zhang Jian's fourth entrepreneurial venture. Now, Noah Medical's Chinese subsidiary, Pulifangzhou Medical Technology Co., Ltd. (hereinafter referred to as "Pulifangzhou"), has localized Galaxy as "Pulibaichuan Bronchoscope Robot" (hereinafter referred to as "Pulibaichuan").

Currently, Puli Baichuan and its supporting disposable consumables have all been approved for market launch by the NMPA.

The new generation of bronchoscopic robots, Pribaichuan

High-precision navigation ≠ high-precision positioning; the first generation of bronchoscopic robots lacked the ability to confirm real-time intraoperative positioning.

"I wanted to make robots when I was in high school." This idea guided Zhang Jian's learning and career path for more than 20 years.

After graduating from Nankai High School in Tianjin, he entered the Department of Automatic Control and Engineering at Harbin Institute of Technology, and later went to Columbia University to pursue a PhD in surgical robotics. After graduating in 2010, he joined Intuitive Surgical, where he was responsible for the mechanical design of the da Vinci IV laparoscope. He was later recruited by Fred Moll, the father of surgical robotics, and became Auris Health's second employee, where he was deeply involved in the product development of the Monarch bronchoscopy robot for the first four years. He left in 2015 (Auris was later acquired by Johnson & Johnson in 2019 for $3.4 billion, setting a record for the highest pre-IPO acquisition in the medical device industry at the time).

Zhang Jian, founder of Noah Medical and Puli Ark

After that, Zhang Jian embarked on a series of entrepreneurial ventures: he successively founded industrial robot company Yifei Automation (now Yifei Intelligent, which has passed the Hong Kong IPO hearing) and disposable hysteroscope company Acuvu. Noah Medical is his third venture as the founder.

Zhang Jian told Arterial Network that when he founded Noah Medical in the fall of 2018, his original intention was to create a disposable endoscopy platform covering multiple departments. However, several American pulmonologist friends reported to him that after performing biopsies on more than 200 patients in a year using Monarch, the biopsy rate was only 76%, far below the initial design target of over 90%. Meanwhile, Ion's clinical trial results in Australia at the same time showed that its biopsy detection rate also remained at the 70-something level.

Why is the biopsy rate of the bronchoscopy robot, developed by two industry giants, their engineering teams, and after years of effort, stuck at around 75%? This intrigued Zhang Jian, an engineer. So, he spent months peeling back the layers and finally clarified the essence of the problem: the first generation of bronchoscopy robots focused on "navigation" but lacked "real-time positioning."

Specifically, Monarch and Ion allow flexible catheters to reach peripheral lung regions that are difficult to access with traditional manual bronchoscopy, theoretically significantly increasing the number of palpable nodules (the number of small peripheral nodules is approximately twice that of the central region). However, the lungs are a dynamic environment, and high-precision navigation does not equal high-precision positioning. Small peripheral nodules (usually referring to lesions with a diameter <2cm, mostly concentrated around 1cm) are located at the edge of the lung lobe and will shift by 3-4cm with the patient's breathing. For solid nodules larger than 3cm in diameter, doctors can still determine their location using a small C-arm fluoroscopy; but once the lesion shrinks to 1cm or even smaller, especially lesions such as ground-glass nodules, the C-arm simply cannot clearly see such tiny and dynamic targets.

More importantly, the first generation of robots heavily relied on preoperative CT scans for path planning, with intraoperative navigation guided only by "Amap-like" systems. However, changes in patient breathing, position, and lung volume during surgery can cause the lesion's location to drift, resulting in a misalignment between the preoperative map and the real-time anatomical structure. Doctors, based on navigation prompts, might mistakenly believe that the biopsy needle has precisely entered the lesion; however, the navigation only displays the catheter's position on the virtual map of the preoperative CT scan. Due to displacement caused by respiratory movements, the actual lesion has already deviated from this coordinate, and the biopsy needle has not actually entered the tumor, naturally hindering the improvement of the biopsy detection rate.

“Navigation is not the same as confirmation. Take driving as an example. Navigation is about ‘driving home from work,’ while location is about determining ‘whether the car is in the garage,’” Zhang Jian explained vividly. “When you drive home using navigation, it will say ‘you have arrived near your destination.’ But to accurately puncture a nodule as small as one centimeter, simply being near it is not enough; you need to pinpoint the exact location to park the car in the garage.” This is the core motivation behind his determination to redesign the next-generation bronchoscopy robot, Galaxy.

Real-time high-precision positioning + all disposable consumables + compact trolley complete the "arrival-confirmation" closed loop for peripheral pulmonary nodules.

As mentioned earlier, although the first generation of bronchoscopic robots has allowed the catheter to reach the distal part of the lung, the lack of real-time intraoperative image fusion and calibration capabilities has prevented doctors from accurately identifying the location of lesions in a dynamic environment, resulting in biopsies not hitting the target with high precision.

As a new generation of bronchoscopic robots, Galaxy has achieved fundamental breakthroughs in two aspects: First, it allows doctors to truly "see" the biopsy process. Equipped with a bronchoscope featuring a high-definition camera and four-way adjustable joints, it can not only stably reach the distal periphery of the lung but also visualize the entire airway movement in real time. Through real-time 3D Imaging DT technology, it provides "real-time positioning" to guide the biopsy procedure, allowing doctors to visually confirm that the biopsy needle has entered the tumor, avoiding repeated punctures. This is particularly advantageous for ground-glass nodules and small peripheral nodules. Second, it uses all-disposable consumables and comes with a complete set of accessories, including all necessary attachments for biopsy, irrigation, and treatment, eliminating cross-infection at the source and significantly improving the efficiency of surgical procedures.

The core of these visualization capabilities lies in the patented 3D Imaging DT technology employed by Pulibaichuan . This technology integrates digital tomography synthesis, 3D reconstruction, enhanced fluoroscopy, and navigation depth, enabling real-time updates and corrections of lesion location during surgery and confirmation that the biopsy tool is within the lesion, effectively overcoming CT-human discrepancies caused by breathing and changes in body position.

Simultaneously, the system can also achieve fluoroscopic enhancement (generating enhanced fluoroscopic blue circles on C-arm fluoroscopic images, intuitively overlaying and displaying the target area) and distance quantification (real-time measurement of the distance and angle between the tool and the lesion), assisting doctors in making high-precision adjustments and avoiding repeated exposures, significantly reducing radiation dose. This combination is like equipping the bronchoscope with a "high-precision navigation + real-time aiming scope," demonstrating a high diagnostic rate and low risk of complications when diagnosing peripheral pulmonary nodules (especially ground-glass nodules).

Enhanced fluoroscopy can overlay the real-time location of lesions onto two-dimensional fluoroscopic images, making lesions that are difficult to visualize under conventional fluoroscopy clearly visible.

The clinical reliability of this technology has been empirically supported. In a clinical study involving 31 subjects (Match 2 Study), the Galaxy system equipped with 3D Imaging DT achieved a 100% navigation and biopsy success rate, with a 93.5% confirmation rate of the biopsy tool in the lesion (TIL) and a 96.7% consistency with the CBCT confirmation results [3] - which means that the location of the lesion "seen" by the doctor during the operation is almost consistent with the gold standard, fully demonstrating the stability and reliability of its dual core capabilities of "arrival + real-time positioning".

Preoperative CT scan shows the location of the target lesion. Intraoperative 3D Imaging (DT) confirms the lesion is located within the lesion. Intraoperative CBCT verifies the lesion is located within the lesion.

3D Imaging (DT) technology offers high reliability for real-time lesion localization, avoiding the significant errors that can occur even with minor oversights.

In terms of product design, the Pulibaichuan main unit trolley occupies only 0.58 square meters, easily adapting to the compact endoscopy rooms in China. The included disposable consumables (bronchoscope, biopsy needles, etc.) are all individually sealed, ready to use and discarded after surgery, requiring no cleaning, disinfection, or maintenance. This not only fundamentally eliminates the risk of cross-infection but also significantly reduces preoperative preparation and postoperative management time, increasing the operating room's turnaround time. This enables community hospitals and primary healthcare institutions to quickly perform high-precision pulmonary nodule diagnosis.

(Insert an image showing the small volume of the Prilis River, such as its placement in an operating room, etc.)

Two points need to be emphasized here. First, Pribivac is not a "laboratory product" starting from scratch. Its international version, the Galaxy system, has completed large-scale clinical validation in markets such as the United States and Australia . As of March 2026, its global clinical commercial application has exceeded 10,000 cases, and multiple studies have confirmed that its rigorous diagnostic rate is over 96%. In November 2025, Pribivac received NMPA approval. As a domestically produced product, it fully retains the technical capabilities of the Galaxy global imaging platform, while leveraging the local Chinese supply chain to optimize costs, making it more competitive in pricing and quality control.

Secondly, the PriBaiChuan surgical robot is a transoral surgical robot that enters through the human respiratory tract, requiring no punctures or skin incisions. This approach has natural advantages for patients with ground-glass opacities, deep nodules, multiple nodules, recurrence after previous surgery, poor cardiopulmonary function that cannot tolerate conventional surgery, and those with special cosmetic or rapid recovery needs.

The product philosophy and value pyramid behind Puli Baichuan: Clinical Value > Clinical Efficiency > Clinical Cost

Technical parameters can be imitated, but the underlying product decision-making logic is difficult to replicate.

In the interview, Zhang Jian repeatedly emphasized that "clinical value (weight 100) > clinical efficiency (weight 10) > clinical cost (weight 1)". This is not only the essence of his product philosophy, but also the key to understanding the differentiated advantages of Puli Ark.

This seemingly simple weighted logic precisely explains an "abnormal" phenomenon of the Galaxy system: its pricing is not cheap, and its disposable consumables are even more expensive than some foreign competitors, yet it continues to grow rapidly in the market; while most imitators of the first generation of products, even with significant price reductions, still struggle to gain traction.

“If a product can solve clinical problems that others cannot, then it is a product worth 100 points.” Zhang Jian believes that clinical efficiency (such as increased surgical turnover rate) and clinical cost (such as reduced equipment price) are just icing on the cake. The former should not be sacrificed for the latter two, because “doctors are buying the ability to solve problems, not the cheapness.”

He cited the da Vinci Surgical System as an example. When it was first introduced, it was expensive and its operational efficiency was not higher than that of traditional laparoscopy. However, it solved the clinical challenge of "precise operation under minimally invasive conditions," so even at the cost of efficiency and cost, it was still accepted by the market. Similarly, the reason why Galaxy was able to quickly achieve commercialization in the United States is that it solved the "invisible" pain point of the first-generation product, increasing the biopsy detection rate from 75% to over 90%—this is a clinical value with a weight of 100, and it is also the moat that Galaxy has built in terms of clinical value.

(Insert photo of a foreign doctor using a Galaxy phone)

Galaxy's all-disposable consumables design not only increases surgical turnover by 15% to 20% and reduces the burden on medical staff, but also "raises the optimism in the operating room." Zhang Jian frankly stated, "We are not cheaper than anyone else in overseas markets, and are even more expensive. But if we get the first two (clinical value and clinical efficiency) right, we can charge a little more." However, he does not intend to engage in a price war in the Chinese market. Instead, he hopes to find a price "suitable for the Chinese market" through local supply chain optimization, lowering the barriers to hospital adoption while maintaining a reasonable gross profit margin.

A two-way framework of "Silicon Valley innovation + China implementation" is being used to create a cross-departmental natural cavity surgical robot platform.

In Zhang Jian's vision, Puli Ark is not a company with a single regional attribute, but a two-way structure of "Silicon Valley innovation + China implementation": the US side is responsible for technological innovation, patent layout and clinical pathway verification, while the Chinese side relies on local supply chain and engineering capabilities to achieve large-scale manufacturing of products and improve clinical accessibility.

This gives Puli Ark a dual advantage: a proven commercial model and capital market-proven financing capabilities in the US market, along with the product quality, cost control, and production efficiency brought by the Chinese engineering team. As Zhang Jian said, "Compared to American companies, we have lower costs, higher quality, and higher efficiency; compared to Chinese companies, we have US patents and can earn more money in the US. This also lays a good foundation for future commercialization in Europe and South America."

2026 marks the commercialization year for Puli Ark in the Chinese market. However, Zhang Jian is not in a hurry to scale up production. Instead, he prioritizes finding pilot hospitals to establish a demonstration effect through benchmark cases before gradually penetrating the market. "We want to unfold the value of our product like a scroll painting," he said.

The next stroke in this grand scheme is the integration of diagnosis and treatment. The core value of Puli Ark lies not only in helping doctors diagnose lung cancer with high accuracy, but also in completing treatment during the same surgery and under the same anesthesia. "Who wants to hear 'The good news is I've diagnosed you with cancer, the bad news is I've diagnosed you with cancer'?" Zhang Jian said. "What we want is: the bad news is you've been diagnosed with cancer, the good news is I've cured you."

This is not only a technological validation, but also an upgrade and closed loop for the business model. When biopsy and treatment are completed in the same surgery, the hospital's revenue structure extends from "upstream screening" to "downstream treatment," while reducing patient trauma and waiting time.

From March 3rd to 4th, 2026, Professor Calvin Ng's team at the Prince of Wales Hospital, Chinese University of Hong Kong, successfully performed three robotic bronchoscopic cryoablation procedures on pulmonary nodules using the PriBio bronchoscopy robot, fully demonstrating the significant value of PriBio in interventional ablation of pulmonary nodules. (Image from the PriBio Ark WeChat Official Account)

The potential of Puli Ark extends far beyond the single market of lung cancer. The underlying logic of its technological system lies in building a common pathway around natural cavities: entering the body through natural cavity systems such as the respiratory tract, without punctures, leaving no scars, and supporting day surgery. This technological system, centered on flexible access, real-time image positioning, and non-invasive diagnosis and treatment, has been fully validated in the lungs, and the path for platform-based replication to other natural cavity departments is now clear. Next, Puli Ark will gradually build a cross-departmental natural cavity surgical robot platform.

From "within reach" to "visible," from "diagnosis" to "treatment," from "lungs" to "the body's natural cavities," the story of Puli Ark has only just begun.

References:

[1]

[2]..

[3] "Understanding 3D Imaging (DT) Technology in One Article"

[4] NoahMedical’s ability to break through and open up platform-based growth space by reconstructing the value of lung cancer diagnosis and treatment through technology

This article was originally published on Arterial Network and is reprinted with permission from Tianjin Puli Ark Medical Technology Co., Ltd. Copyright belongs to the original author. Please contact the original source for reprint permission. This article does not constitute medical advice; please consult your doctor for specific diagnosis and treatment.