50 years of minimally invasive surgery in Urology

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-chairR). 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 RoboflexR and the AquaBeamR-System for robot-assisted aquablation therapy of the prostate. While RoboflexR improves the ergonomics of flexbile ureteroscopy, AquaBeamR may for the first time eliminate the surgeon.