50 Jahre Minimal-invasive Chirurgie in der Urologie

Jens J. Rassweiler; Goezen Ali Serdar; Jan Klein; Marie-Claire Rassweiler-Seyfried

doi:10.1055/a-0970-6982

Aktuelle Urologie, Table of Contents

Aktuelle Urol 2019; 50(06): 593-605
DOI: 10.1055/a-0970-6982

Übersicht

50 Jahre Minimal-invasive Chirurgie in der Urologie

50 years of minimally invasive surgery in Urology

Jens J. Rassweiler

¹Klinik für Urologie und Kinderurologie der SLK Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg (Ärztl. Dir.: Prof. Dr. med. J. Rassweiler)

,

Goezen Ali Serdar

¹Klinik für Urologie und Kinderurologie der SLK Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg (Ärztl. Dir.: Prof. Dr. med. J. Rassweiler)

,

Jan Klein

²Urologische Klinik der Universität Ulm, Ulm (Ärztlicher Direktor: Prof. Dr. med. C. Bolenz)

,

Marie-Claire Rassweiler-Seyfried

³Urologische Klinik Univeristätsklinikum Mannheim, Mannheim (Ärztl. Dir.: Prof. Dr. med. M-S. Michel)

› Author Affiliations

Abstract

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

Full Text

References

Literatur
1 Haupt G, Pannek J, Benkert S. et al. Transurethral resection of the prostate with microprocessor controlled electrosurgical unit. J Urol 1997; 158: 497
2 Rassweiler J, Schulze M, Stock C. et al. Bipolar transurethral resection of the prostate - technical modifications and early clinical experience. Minimally Invasive Therapy 2007; 16: 11-21
3 Barba M, Fastenmeier K, Hartung R. Electrocautery: Principles and practice. J Endourol 2003; 17: 541-555
4 Rassweiler J, Teber D, Kuntz R. et al. Complications of transurethral resection of the prostate (TURP) - incidence, management, and prevention. Eur Urol 2006; 50: 969-980
5 Mamoulakis C, Skolarikos A, Schulze M. et al. Results from an international multicentre double-blind randomization controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate. BJU Int 2012; 109: 240-248
6 Reuter HJ, Jones LW. Physiologic low pressure irrigation for transurethral resection for transurethral resection: suprapubic trocar drainage. J Urol 1974; 111: 210-213
7 Iglesias JJ, Stams UK. Das neue Iglesias-Resektoskop. Urologe A 1975; 14: 229-231
8 Mauermayer W, Hartung R. Filmaufnahmen von offenen Operationen mit einem neuen TUR-Videosystem. Urologe A 1981; 20: 102-104
9 Faul P. Video-TUR: raising the gold standard. Eur Urol 1993; 24: 256-261
10 Muschter R, Reich O. Operative und instrumentelle Therapie bei BPH/BPS. Urologe A 2008; 47: 155-165
11 Kramer MW, Rassweiler JJ, Klein J. et al. En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol 2015; 33: 1937-1943
12 Kramer MW, Altieri V, Hurie R. et al. Current evidence of transurethral en-bloc resection of nonmuscle invasive bladder cancer: Update 2016. Eur Urol Focus 2017; 3: 567-576
13 Miernik A, Gross AJ, Schoeb DS. et al. Endoskopische Enucleation der Prostata. Urologe A 2019; 58: 437-450 epub ahead of print
14 Rassweiler J, Roder M, Schulze M. et al. Transurethrale Laserenukleation der Prostata mit dem Holmiumlaser: Wieviel Leistung ist nötig?. Urologe A 2008; 47: 441-448
15 Harris SJ, Arambula-Cosio F, Mei Q. et al. The Probot--an active robot for prostate resection. Proc Inst Mech Eng H 1997; 211: 317-325
16 Gilling P, Reuther R, Kahokehr A. et al. Aquablation – image-guided robot-assisted water-jet ablation. BJU Int 2016; 117: 923-929
17 Bach T, Giannakis I, Bachmann A. et al. Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort. World J Urol 2018; [Epub ahead of print]
18 Rassweiler JJ, Goezen AS, Rassweiler-Seyfried MC. et al. Roboter in der Urologie eine Analyse gegenwärtiger und zukünftiger Gerätegenerationen. Urologe A 2018; 57: 1075-1090
19 Pickens RB, Bajo A, Simaan N. et al. A pilot ex vivo evaluation of a telerobotic system for transurethral intervention and surveillance. J Endourol 2015; 29: 231-234
20 Fernström I, Johannson B. Percutaneous pyelolithotomy: A new extraction technique. Scand J Urol Nephrol 1976; 4: 257
21 Kauffmann GW, Wenz W, Rohrbach R. et al. Renal embolization – Indications and material. Ann Radiol 1981; 24: 386-389
22 Kauffmann GW, Rohrbach R, Richter G. et al. Fortschritte, Erfahrungen und Komplikationen. Urologe A 1984; 23: 109-116
23 Rassweiler J, Eisenberger F, Buck J. Stumpfes Nierentrauma – operative oder konservative Therapie ?. Unfallchirurgie 1983; 9: 274-279
24 Eisenberger F, Schmiedt E, Pfeifer KJ. et al. In-situ Perfusion und Kühlung der Niere beim Ausgußstein. Münch Med Wochenschr 1973; 115: 404-449
25 Alken P, Hutschenreiter R, Günther M. et al. Percutaneous stone manipulation. J Urol 1981; 125: 463-466
26 Kauffmann GW, Rassweiler J, Richter G. et al. Capillary embolization with Ethibloc: New embolization concept tested in dog kidneys. Amer J Roentgen 1981; 137: 1163-1168
27 Rassweiler J, Kauffmann GW, Richter G. et al. Experimental basis of angioinfarction for the treatment of renal hypertension. Urol Int 1986; 41: 42-56
28 Rassweiler J, Kauffmann G, Jäger R. et al. Die kapilläre Embolisation mit Ethibloc bei renaler Hypertonie - eine Alternative zur Nephrektomie. Tierexperimentelle Untersuchungen am Hochdruckmodell der Ratte. Akt Urol 1984; 15: 1-8
29 Gebreamlack T, Kurzidem M, Tesdal IK. et al. Efficacy and limitation of capillary chemoembolization with Ethibloc/Mitomycin C in a renal cell carcinoma with thrombus in vena cava (stage III). Akt Urol 1997; 28: 174-177
30 Rassweiler J, Prager P, Haferkamp A. et al. Transarterial nephrectomy: the current status of experimental and clinical studies. J Endourol 2008; 22: 767-782
31 Fichtner J, Swoboda A, Hutschenreiter G. et al. Percutaneous embolisation of the kidney: indications and clinical results. Akt Urol 2003; 34: 475-477
32 Gallucci M, Guaglianone S, Carpanese L. et al. Superselective Embolization as first step of laparoscopic partial nephrectomy. Urology 2007; 69: 642-646
33 Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51: 899-906
34 Zumstein V, Betschart P, Vetterlein MW. et al. Prostatic Artery Embolization versus Standard Surgical Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. Eur Urol Focus 2018;
35 Sommer CM, Lemm G, Hohenstein E. et al. CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma: specific technical aspects and clinical results. Cardiovasc Interv Radiol 2013; 36: 731-737
36 Reuter HJ. Transurethrale Ultraschalllithotripsie im Ureter. Akt Urol 1984; 15: 28-31
37 Perez-Castro EllendtE, Martinez-Pinero JA. Ureteral and renal endoscopy. Eur Urol 1982; 8: 258-260
38 Chaussy C, Schmiedt E, Jocham D. et al. First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. J Urol 1982; 127:: 417-420
39 Häusler E, Kiefer W. Nierensteinzertrümmerung mit geführten Stosswellen. Ann Univ Saraviensis 1974; (Verh Ber Dt Ges Phys) 11: 150-159
40 Eisenberger F, Chaussy C, Wanner K. Extrakorporale Anwendung von hochenergetischen Stoßwellen. Ein neuer Aspekt in der Behandlung des Harnsteinleidens. Akt Urol 1977; 8: 3-15
41 Chaussy C, Eisenberger F, Wanner K. et al. Extrakorporale Anwendung von hochenergetischen Stoßwellen. Ein neuer Aspekt in der Behandlung des Harnsteinleidens (Teil 2). Akt Urol 1978; 9: 95-102
42 Fuchs G, Miller K, Rassweiler J. et al. Extracorporeal shock wave lithotripsy: one-year experience with the Dornier lithotripter. Eur Urol 1985; 11: 145-149
43 Rassweiler J, Hath U, Lutz K. et al. In-situ ESWL beim distalen Harnleiterstein – das Ende der Zeiss-Schlinge?. Akt Urol 1986; 17: 328-331
44 Eisenberger F, Rassweiler J. Extrakorporale Stoßwellenlithotripsie im Wandel. Akt Urol 1986; 17: 229-233
45 Rassweiler J, Lutz K, Gumpinger R. et al. The efficacy of in-situ ESWL for upper ureteral calculi. Eur Urol 1987; 13: 32-36
46 Miller K, Fuchs G, Bub P. et al. Kombination von perkutaner Nephrolithotomie (PCN) und extrakorporaler Stoßwellemlithotriopsie – eine neue Möglichkeit der Behandlung von Nierensteinen. Akt Urol 1984; 15: 317-321
47 Eisenberger F, Fuchs G, Miller K. et al. Extracorporeal shockwave lithotripsy (ESWL) and endourology: an ideal combination for the treatment of kidney stones. World J Urol 1985; 3: 41-47
48 Rassweiler J, Gumpinger R, Miller K. et al. Multimodal treatment of complicated renal stone disease. Eur Urol 1986; 12: 294-304
49 Rassweiler J, Westhauser A, Bub P. et al. Second-generation lithotripters: A comparative study. J Endourology 1988; 2: 193-203
50 Rassweiler J, Gumpinger R, Bub P. et al. Efficacy and range of indications. Eur Urol 1989; 16: 1-6
51 Rassweiler J, Henkel TO, Köhrmann KU. et al. Lithotripter technology: Present and future. J Endourol 1992; 6: 1-13
52 Knoll T, Fritsche HM, Rassweiler J. Medizinische und ökonomische Aspekte der ESWL. Akt Urol 2011; 42: 363-367
53 Rassweiler JJ, Knoll T, Köhrmann KU. et al. Shock wave technology and application – an update. Eur Urol 2011; 59: 784-796
54 Schnabel MJ, Brummeisl W, Burger M. et al. Stosswellenlithotripsie in Deutschland: Ergebnisse eine bundesweiten Umfrage. Urologe A 2015; 54: 1277-1282
55 Abdel-Salam Y, Budair Z, Renner C. et al. Treatment of Peyronieʼs Disease by Extracorporeal Shockwave Therapy: Evaluation of our preliminary results. J Endourol 1999; 13: 549-552
56 Rassweiler J. Re: Extracorporeal shock wave therapy (ESWT) in Urology: A systematic review of outcome in Peyronie`s disease, erectile dysfunction, and chronic pain. (Words of Wisdom). Eur Urol 2018; 74: 115-117
57 Wickham JE, Kellet MJ. Percutaneous nephrolithotomy. BJU 1981; 53: 297-299
58 Desai M. Ultrasonography-guided punctures - with and without puncture guide. J Endourol 2009; 23: 1641-1643
59 Rassweiler J, Rassweiler M-C, Klein J. New technology and percutaneous nephrolithotomy. Current Opin Urol 2016; 26: 95-106
60 Heinze A, Goezen AS, Rassweiler J. Tract sizes in percutaneous nephrolithotomy: does miniaturization improve outcome. Curr Opin Urol 2019; 29: 118-123
61 Häcker A, Bachmann A, Herrmann T. et al. Operative Technik der perkutanen Nephrolithotomie. Urologe A 2016; 55: 1375-1386
62 Su LM, Stoianovici D, Jarrett TW. et al. Robotic percutaneous access to the kidney: comparison with standard manual access. J Endourol 2002; 16: 471-475
63 Pollok R, Mozer P, Guzzo TJ. et al. Prospects in percutaneous ablative targeting: comparison of a computer-assisted navigation system and the AcuBot robotic system. J Endourol 2010; 24: 1269-1272
64 Baumhauer M, Feuerstein M, Meinzer HP. et al. Navigation in endoscopic soft tissue surgery – perspectives and limitations. J Endourol 2008; 22: 751-766
65 Rassweiler JJ, Müller M, Fangerau M. et al. iPad-assisted percutaneous access to the kidney using marker-based navigation: initial clinical experience. Eur Urol 2011; 61: 628-631
66 Rassweiler-Seyfried MC, Rassweiler JJ, Weiss C. et al. iPad-assisted percutaneous nephrolithotomy (PCNL): a matched pair analysis compared to standard PCNL. World J Urol 2019; [Epub ahead of print]
67 Ritter M, Rassweiler MC, Michel MS. The Uro Dyna-CT Enables Three-dimensional Planned Laser-guided Complex Punctures. Eur Urol 2015; 68: 880-884
68 Rodrigues PL, Vilaça JL, Oliveira C. et al. Collecting system percutaneous access using real-time tracking sensors: first pig model in vivo experience. J Urol 2013; 190: 1932-1937
69 Rassweiler J, Irion U, Strauss R. et al. Technical considerations using a pulsed Neodym-YAG laser for endoscopic shock wave lithotripsy. Eur. Urol 1989; 16: 374-377
70 Rassweiler J, Henkel T, Tschada R. et al. Interdisciplinary experience with the Lithognost: Impact of optical feedback-controlled stone detection in lasertripsy. J Endourol 1992; 6: 233-237
71 Kronenberg P, Traxer O. Update on Lasers in Urology. Current assessment on holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripter settings and laser fibers. World J Urol 2015; 33: 1030-1035
72 Neisius A, Lipkin ME, Rassweiler JJ. et al. Shock wave lithotripsy: The new phoenix?. World J Urol 2015; 33: 213-221
73 Klein J, Netsch C, Sievert KD. et al. Extrakorporale Stosswellenlithotripsie. Urologe A 2018; 57: 463-473
74 Gross AJ, Rassweiler J, Sievert KD. et al. Ureterorenoskopie. Urologe A 2017; 56: 395-404
75 Secker A, Rassweiler J, Neisius A. Future perspectives of flexible ureteroscopy. Curr Opin Urol 2019; 29: 113-117
76 Desai MM, Grover R, Aron M. et al. Robotic flexible ureteroscopy for renal calculi: initial clinical experience. J Urol 2011; 186: 563-568
77 Saglam R, Muslumanoglu AY, Tokatlı Z. et al. A new robot for flexible ureteroscopy: Development and early clinical results (IDEAL Stage 1-2b). Eur Urol 2014; 66: 1092-1110
78 Rassweiler J, Fiedler M, Charalampogiannis N. et al. Robot-assisted flexible ureteroscopy: an update. Urolithiassis 2018; 46: 69-77
79 https://www.geekfence.com/2018/03/24/monarch-is-a-new-platform-from-surgical-robot-pioneer-frederic-moll/
80 Rassweiler J, Goezen AS, Klein J-T. et al. Zukunft der Laparoskopie und Robotik in der Urologie. Akt Urol 2018; 49: 488-499
81 Kelling G. Über die Oesophagoskopie, Gastroskopie und Koelioskopie. Münch med Wschr 1901; 49: 21-24
82 Semm K. Endoscopic appendicectomy. Endoscopy 1983; 15: 59-64
83 Cortesi N, Ferrari P, Zambarda E. et al. Diagnosis of bilateral abdominal cryptorchidism by laparoscopy. Endoscopy 1976; 8: 33-34
84 Clayman RV, Kavoussi LR, Soper NJ. et al. Laparoscopic nephrectomy: initial case report. J Urol 1991; 146: 278-282
85 Rassweiler JJ, Henkel TO, Potempa DM. et al. Die Technik der transperitonealen laparoskopischen Nephrektomie (TLN) - experimentelle Grundlagen und erste klinische Erfahrungen. Akt Urol 1992; 23: 220-228
86 Gaur D. Laparoscopic operative retroperitoneoscopy. J Urol 1992; 148: 1137-1139
87 Rassweiler JJ, Henkel TO, Stock Ch. et al. Retroperitoneale laparoskopische Nephrektomie (RLN) und andere retroperitoneoskopische Eingriffe - Technik und erste Ergebnisse. Akt Urol 1994; 25: 154-166
88 Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: The Montsouris technique. J Urol 2000; 163: 1643-1649
89 Rassweiler J, Sentker L, Seemann O. et al. Laparoskopische radikale Prostatektomie – Technik und erste Erfahrungen. Akt Urol 2000; 31: 238-247
90 Rassweiler J, Stolzenburg J, Sulser T. et al. Laparoscopic radical prostatectomy – the experience of the German Laparoscopic Working Group. Eur Urol 2006; 49: 113-119
91 Tokas T, Goezen AS, Avgeris M. et al. Combining of ETHOS operating ergonomic platform, three-dimensional laparoscopic camera and Radius Surgical System manipulators improves ergonomy in urologic laparoscopy: Comparison with conventioneal laparoscopy and da Vinci in a pelvi trainer. Eur Urol Focus 2017; 3: 413-420
92 Rassweiler JJ, Klein J, Tschada A. et al. Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair: demonstration of technique and matched-pair analysis. BJU Int 2017; 119: 349-357
93 Rassweiler J, Klein J, Goezen AS. Retroperitoneal laparoscopic non-dismembered pyeloplasty for uretero-pelvic obstruction due to crossing vessels: A matched-paired analysis and review of the literature. Asian J Urol 2018; 5: 172-181
94 Jaspers JEN, Bentala M, Herder JL. et al. Mechanical manipulator for intuitive control of endoscopic instruments with seven degrees of freedom. Min Invas Ther and Allied Technol 2004; 13: 191-198
95 Rassweiler J, Binder J, Frede T. Robotic and telesurgery: will they change our future. Curr Opin Urol 2001; 11: 309-320
96 Binder J, Kramer W. Robotically assisted radical prostatectomy. BJU Int 2001; 87: 408-410
97 Schurr MO, Buess G, Neisius B. et al. Robotics and telemanipulation technologies for endoscopic surgery. A review of the ARTEMIS project. Surg Endosc 2000; 14: 375-381
98 Reichenspurner H, Damiano R, Mack M. et al. Use of the voice-controlled surgical system ZEUS for endoscopic coronary bypass grafting. J Thorac Cardiovasc Surg 1999; 118: 11-16
99 Mohr FW, Falk V, Diegeler A. et al. Computer-enhanced coronary artery surgery. J Thorac Cardiovasc Surg 1999; 117: 1212-1215
100 Marescaux J, Leroy J, Gagner M. et al. Transatlantic robot-assisted telesurgery. Nature 2001; 413: 379-380
101 Menon M, Shrivastava A, Tewari A. et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 2002; 168: 945-949
102 Rassweiler JJ, Autorino R, Klein J. et al. Future of robotic surgery in urology. BJU Int 2017; 120: 822-841
103 Darwich I, Stephan D, Klöckner-Lang M. et al. A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance™ Surgical Robotic System: results and technical aspects. J Robot Surg 2019; [Epub ahead of print]
104 Kim DD, Park DW, Rha KH. Robot-assisted partial nephrectomy with the REVO I-robot platform in porcine models. Eur Urol 2016; 69: 541-542
105 Hagn U, Konietschke R, Tobergte A. et al. DLR Miro Surge: a versatile system for research in endoscopic telesurgery. Int J Comput Assist Radiol Surg 2010; 5: 183-189
106 Kaouk JH, Haber GP, Autorino R. et al. A novel robotic system for single-port urologic surgery: First clinical investigation. Eur Urol 2014; 66: 1033-1043
107 Kaouk J, Garisto J, Eltemamy M. et al. Step-by-step technique for single-port robot-assisted radical cystectomy and pelvic lymph nodes dissection using the da Vinci® SP™ surgical system. BJU Int 2019; [Epub ahead of print]
108 Seeliger B, Diana M, Ruurda JP. et al. Enabling single-site laparoscopy: the SPORT platform. Surg Endosc 2019; [Epub ahead of print]
109 Breda A, Territo A, Gausa L. et al. Robot-assisted kidney transplantation: The European experience. Eur Urol 2018; 73: 273-281