50 Jahre Minimal-invasive Chirurgie in der Urologie

Zusammenfassung

Die Entwicklung der Minimal-invasiven Chirurgie (MIC) in der Urologie umfasst die Teilbereiche transurethrale Techniken, Endourologie und Extrakorporale Stosswellenlithotripsie, Uroradiologie sowie Laparoskopie und Robotische Chirurgie. Basierend auf persönlichen Erfahrungen mit der Entwicklung minimal-invasiver Verfahren seit Ende der 70iger Jahren präsentieren wir eine historische Analyse der Literatur mit dem Ziel, die wesentlichen Meilensteine der Minimal-Invasiven Therapie in der Urologie herauszuarbeiten.

Motor der rasanten Entwicklung der MIC in der Urologie war die Einführung der digitalen Videotechnologie, Lasertechnologie, Fortschritte der Elektrochirurgie begleitet von den Glanzleistungen vor allem Deutscher Technologiefirmen mit zunehmender Miniaturisierung des Instrumentariums. Bedeutsam war auch die gute Kooperation zwischen Urologen, Ingenieuren und Radiologen.

Die Laparoskopie wird trotz zahlreicher Weiterentwicklungen (3D-Prismentechnolgie, ETHOS-chair) zunehmend von der Robotik ersetzt. Auf Grund der auslaufendenden Patenten von Intuitive Surgical existiert seit diesem Jahr eine Konkurrenzsituation mit neuen Herstellern von Operationsrobotern. Allerdings müssen diese erst belegen, ob sie den hohen Qualitätsstandard der aktuellen Da Vinci-serie bieten können. Robotersysteme für die Endourologie werden zukünftig eine Rolle spielen, wie Avicenna Roboflex^R für die flexible Ureteroskopie und AquaBeam^R- für die roboter-assistierte Aquaablation der Prostata. Während Roboflex^R ähnlich dem Da Vinci-system die Ergonomie des Eingriffes erleichtert, ersetzt die robotergestützte Aquablation erstmals den Operateur.

Abstract

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^R). 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^R and the AquaBeam^R-System for robot-assisted aquablation therapy of the prostate. While Roboflex^R improves the ergonomics of flexbile ureteroscopy, AquaBeam^R may for the first time eliminate the surgeon.

Schlüsselwörter

minimal invasive Chirurgie - chirurgische Roboter - Laparoskopie - Endourologie - Navigation - Master-Slave Systeme - Roboter-assistierte Chirurgie - Robotische flexible Ureteroskopie - Robotische TURP - Aquablation der Prostata - TUR Prostate, Laser Enukleation

Keywords

minimally invasive surgrey - surgical robots - laparoscopy - endourology - Navigation - master-slave systems - robot-assisted surgery - robotic flexible ureteroscopy - robotic TURP - aquablation of the prostate - TUR prostate, laser enucleation

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