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  • Review Article
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Advances in laparoscopic surgery in urology

Nature Reviews Urology volume 13, pages 387–399 (2016)Cite this article

Subjects

Key Points

  • Robot-assisted surgery has revolutionized laparoscopy, particularly enabling surgeons with no laparoscopic training to learn and perform reconstructive procedures with a shortened learning curve

  • Laparoscopic surgery will benefit from new developments, such as 4K ultrahigh-definition and 3D high-definition video technology, flexible instruments, suturing devices, and sealing devices using bipolar and ultrasound technology

  • Sophisticated camera holders and ergonomic platforms, enabling the surgeon to perform the procedure in a sitting position or with arm and chest support, will further benefit laparoscopic surgery

  • The use of specific platforms for single-site surgery might increase the application of laparoendoscopic single-site surgery for urological indications

  • Laparoscopy remains an important surgical technique, particularly for ablative procedures

  • Distribution of robot-assisted surgery is limited by high purchase and maintenance costs for the only existing robotic system, but new robots are expected soon

Abstract

In the past 10 years, laparoscopy has been challenged by robotic surgery; nevertheless, laparoscopic techniques are subject to continuous change. Ultrahigh definition is the next development in video technology, it delivers fourfold more detail than full high definition resulting in improved fine detail, increased texture, and an almost photographic emulsion of smoothness of the image. New 4K ultrahigh-definition technology might remove the current need for the use of polarized glasses. New devices for laparoscopy include advanced sealing devices, instruments with six degrees of freedom, ergonomic platforms with armrests and a chest support, and camera holders. A manually manipulated robot-like device is still at the experimental stage. Robot-assisted surgery has substantially revolutionized laparoscopy, increasing its distribution; however, robot-assisted surgery is associated with considerable costs. All technical improvements of laparoscopic surgery are extremely valuable to further simplify the use of classical laparoscopy.

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Figure 1: Illustration of a generic trocar and canula.
Figure 2: Illustration of endoscopic suturing devices.
Figure 3: Basic camera-holder designs.

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Authors and Affiliations

  1. Department of Urology, SLK-Kliniken Heilbronn, Am Gesundbrunnen 20–26, Heilbronn, Heidelberg, 74078, Germany

    Jens J. Rassweiler

  2. Department of Urology, Medical School Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany

    Dogu Teber

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Both authors researched data for the manuscript, discussed the content, wrote the article, and reviewed and edited the manuscript before submission.

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Correspondence to Jens J. Rassweiler.

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Competing interests

J.J.R. was involved in the development of the ETHOS™ chair but did not receive any financial compensation or support for his involvement. Karl Storz (Germany) supports the laparoscopic training centre of the Department of Urology, SLK Kliniken Heilbronn, Germany. D.T. has nothing to disclose.

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Rassweiler, J., Teber, D. Advances in laparoscopic surgery in urology. Nat Rev Urol 13, 387–399 (2016). https://doi.org/10.1038/nrurol.2016.70

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