Rassweiler Jens J, Serdar Goezen Ali, Klein Jan, Rassweiler-Seyfried Marie-Claire
Klinik für Urologie und Kinderurologie der SLK Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg (Ärztl. Dir.: Prof. Dr. med. J. Rassweiler).
Urologische Klinik der Universität Ulm, Ulm (Ärztlicher Direktor: Prof. Dr. med. C. Bolenz).
Aktuelle Urol. 2019 Dec;50(6):593-605. doi: 10.1055/a-0970-6982. Epub 2019 Oct 9.
The development of minimally invasive surgery (MIS) in Urology includes transurethral techniques, endourology and extracorporeal shock wave lithotripsy, uroradiology as well as laparoscopy and robot-assisted suregry. Based on personal experiences with the introduction of minimal-invasiven procedures since the late seventees we present a historical analysis of the literature aiming to work out the most important milestones of MIS in Urology.The drastic development of MIS in Urology was promoted by the introduction of digital videotechnology, laser technology, advances in electronic surgery together with the excellent performance of mainly German manufacturers of medical devices anf instruments. In this scenario, the good cooperation between urologists, engineers, and interventional radiologists was of upmost importance.The introduction of Robotics led to a decrease of importance of classical laparoscopy. Nevertheless laparoscopy and retroperitoneoscopy underwent significant technological improvements during the last decade including introduction 3D-HD-videosystems and ergonomic platforms (ETHOS-chair). The monopoly of robotic surgical devices will end this year, because key-patents of Intuitive Surgical will expire. This will lead to an interesing competition in among new manufacturers of robotic surgical devices, which however have to prove that they meet the high quality standard of the current Da Vinci-series. There are also robotic systems used in endourology: Avicenna Roboflex and the AquaBeam-System for robot-assisted aquablation therapy of the prostate. While Roboflex improves the ergonomics of flexbile ureteroscopy, AquaBeam may for the first time eliminate the surgeon.
泌尿外科微创手术（MIS）的发展包括经尿道技术、腔内泌尿外科和体外冲击波碎石术、泌尿放射学以及腹腔镜检查和机器人辅助手术。基于自20世纪70年代末以来引入微创程序的个人经验，我们对文献进行了历史分析，旨在梳理出泌尿外科MIS的最重要里程碑。数字视频技术、激光技术、电子手术的进步以及主要德国医疗器械和仪器制造商的卓越性能推动了泌尿外科MIS的迅猛发展。在这种情况下，泌尿外科医生、工程师和介入放射科医生之间的良好合作至关重要。机器人技术的引入导致传统腹腔镜检查的重要性下降。然而，在过去十年中，腹腔镜检查和后腹腔镜检查经历了重大技术改进，包括引入3D高清视频系统和符合人体工程学的平台（ETHOS椅）。机器人手术设备的垄断将于今年结束，因为直观外科公司的关键专利将到期。这将在机器人手术设备的新制造商之间引发一场有趣的竞争，不过这些制造商必须证明他们符合当前达芬奇系列的高质量标准。腔内泌尿外科也使用机器人系统：用于前列腺机器人辅助水消融治疗的阿维森纳Roboflex和水束系统。虽然Roboflex改善了可弯曲输尿管镜检查的人体工程学，但水束系统可能首次无需外科医生操作。
