Miernik A, Hein S, Adams F, Halbritter J, Schoenthaler M
Klinik für Urologie, Universitätsklinik Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
Max Planck-Institut für Intelligente Systeme, Stuttgart, Deutschland.
Urologe A. 2016 Oct;55(10):1309-1316. doi: 10.1007/s00120-016-0227-x.
Urological and surgical treatment of urinary stones are highly technological and technology-driven disciplines in present-day surgery. German medical engineering has always been recognized for its technical innovations in endoscopic surgery. Current and future trends are indicative of further miniaturization and automation of surgical instruments and assist systems to facilitate endourological procedures as well as improvements in the quality of results and ergonomics. These technologies include, e. g. 3D-tracking to facilitate access to the pelvicaliceal system for percutaneous nephrolithotomy (PNL) or robotic master-slave systems for endourology. The aim of all future stone treatment should be complete stone removal. This could be achieved by improved stone fragmentation ("micron-sized debris") or complete removal of fragments (e. g. using a "stone glue"). Integration of diagnostic procedures and treatments will constitute a key aspect of future developments in medical engineering. Intelligent laser systems may be capable of distinguishing stones from mucosa and artificial surfaces and may be used for immediate stone analysis during surgery. A simpler and faster availability of metabolic ("metabolomics") and genetic ("genomics") diagnostics will help to facilitate and improve individual metaphylaxis, e. g. in patient self-management. Nanotechnology and microrobots that may be used for endoluminal diagnostics and treatment of the urinary tract are already in development.
在当今外科手术中，泌尿系统结石的泌尿外科治疗和外科治疗是技术高度密集且由技术驱动的学科。德国医学工程一直以其在内镜手术方面的技术创新而闻名。当前和未来的趋势表明，手术器械和辅助系统将进一步小型化和自动化，以促进腔内泌尿外科手术，并提高手术效果质量和人体工程学性能。这些技术包括，例如用于经皮肾镜取石术（PNL）时便于进入肾盂肾盏系统的三维跟踪技术，或用于腔内泌尿外科的机器人主从系统。未来所有结石治疗的目标都应该是完全清除结石。这可以通过改进结石破碎（“微米级碎片”）或完全清除碎片（例如使用“结石胶水”）来实现。诊断程序和治疗的整合将成为医学工程未来发展的一个关键方面。智能激光系统或许能够区分结石与黏膜及人造表面，并可用于手术期间的即时结石分析。代谢（“代谢组学”）和基因（“基因组学”）诊断更简便、更快速地可得，将有助于促进和改善个体预防措施，例如在患者自我管理方面。可用于腔内诊断和治疗尿路的纳米技术和微型机器人已经在研发中。
