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
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.
This is a preview of subscription content, access via your institution
Open Access articles citing this article.
Utility of total cell-free DNA levels for surgical damage evaluation in patients with urological surgeries
Scientific Reports Open Access 11 November 2021
Subscribe to this journal
Receive 12 print issues and online access
$189.00 per year
only $15.75 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Rassweiler, J., Binder, J. & Frede, T. Robotic and telesurgery: will they change our future? Curr. Opin. Urol. 11, 309–320 (2001).
Albisinni, S. et al. Long-term analysis of oncologic outcomes after laparosopic radical cystectomy in Europe: results from a multicentric study of EAU-section of Uro-Technology. BJU Int. 115, 937–945 (2015).
Lusch, A. et al. Comparison of optics and performance of distal sensor high definition cystoscope, a distal sensor standard definition cystoscope, and a fiberoptic cystoscope. Urology 85, 268–272 (2015).
Schurr, M. O., Kunert, W., Arezzo, A. & Buess, G. The role and future of endoscopic imaging systems. Endoscopy 71, 557–562 (1999).
TrueVision, Microsurgery Teaching System. [online]
Acharya, S. Ultra high definition televsion: threshold of a new age. ITU [online], (2012).
Bach, T. et al. Technical solutiona to improve the management of non-invasive transitional cell carcinoma: summary of European Association of Urology Section of Uro-Technology (ESUT) and Section for Uro-Oncology (ESOU) expert meeting and current and future perspectives. BJU Int. 115, 14–23 (2015).
Rassweiler, J. & Frede, T. Robotics, telesurgery and telementoring — their position in modern urological laparoscopy. Arch. Esp. Urol. 55, 610–628 (2002).
Breedveld, P., Stassen, H. G., Meijer, D. W. & Stassen, L. P. S. Theoretical background and conceptual solution for depth perception and eye-hand coordination problems in laparoscopic surgery. Minim. Invasive Ther. Allied Technol. 8, 227–234 (1999).
Rassweiler, J., Gözen, A. S., Frede, T., Teber, D. in Robotics in Genitourinary Surgery (eds Hemal, A. K. & Menon, M.) 63–78 (Springer, 2011).
Izquierido, L. et al. Recent advances in natural orifice transluminal endoscopic surgery in urologic surgery. Int. J. Urol. 20, 462–466 (2013).
McDougall, E. M. et al. Comparison of three-dimensional and two-dimensional laparoscopic video systems. J. Endourol. 10, 371–374 (1996).
Cicione, A. et al. Three-dimensional versus standard laparoscopy: comparative assessment using a validated program for laparoscopic skills. Urology 82, 1444–1450 (2013).
Neudecker, J. et al. The European Association for Surgery Clinical Practice Guideline on the pneumoperitoneum for laparoscopic surgery. Surg. Endosc. 16, 1121–1143 (2002).
Wind, J. et al. Medical liability insurance claims on entry-related complications in laparoscopy. Surg. Endosc. 21, 2094–2099 (2007).
Vilos, G. A., Ternamian, A., Dempter, J. & Laberge, P. Y. Laparoscopic entry: a review of techniques, technologies, and complications. J. Obstet. Gynaecol. Can. 29, 433–447 (2007).
Krishnakumar, S. & Tambe, P. Entry complications in laparoscopic surgery. J. Gynecol. Endosc. Surg. 1, 4–11 (2009).
Shafer, D. M., Khajanchee, Y., Wong, J. & Swanström, L. L. Comparison of five different abdominal access trocar systems: analysis of insertion force, removal force, and defect size. Surg. Innov. 13, 183–189 (2006).
Feste, J. R., Bojahr, B. & Turner, D. J. Randomized trial comparing a radially expandable needle system with cutting trocars. JSLS 4, 11–15 (2000).
Venkatesh, R. et al. Prospective randomized comparison of cutting and dilating disposable trocars for access during laparoscopic renal surgery. JSLS 11, 198–203 (2007).
Antoniou, S. A., Antoniou, G. A., Koch, O. O., Pointner, R. & Granderath, F. A. Blunt versus bladed trocars in laparoscopic surgery: a systematic review and meta-analysis of randomized trials. Surg. Endosc. 27, 2312–2320 (2013).
McKernan, J. & Finley, C. Experience with optical trocar in performing laparoscopic procedures. Surg. Laparosc. Endosc. 12, 96–99 (2002).
Glass, K. B., Tarnay, C. M. & Munro, M. G. Intraabdominal pressure and incision parameters associated with a pyramidal laparoscopic trocar-cannula system and the EndoTIP cannula. J. Am. Assoc. Gynecol. Laparosc. 9, 508–513 (2002).
Herati, A. S. et al. Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars. Urology 77, 1126–1132 (2011).
Nepple, K. G., Kallogjeri, D. & Bhayani, S. B. Benchtop evaluation of pressure barrier insufflator and standard insufflator systems. Surg. Endosc. 27, 333–338 (2013).
Horstmann, M., Horton, K., Kurz, M., Padevit, C. & John, M. Prospective comparison between the AirSeal® System valve-less trocar and a standard VersaportPlus V2™ trocar in robotic-assisted radical prostatectomy. J. Endourol. 27, 579–582 (2013).
Solaini, L. et al. Advanced sealing and dissecting devices in laparoscopic adrenal surgery. JSLS 17, 622–626 (2013).
Fagotti, A. et al. Randomized study comparing use of THUNDERBEAT versus standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer. J. Minim. Invasive Gynecol. 21, 447–453 (2014).
Vilos, G. & Rajakumar, C. Electrosurgical generators and monopolar and bipolar electrosurgery. J. Minim. Invasive Gynecol. 20, 279–287 (2013).
Gözen, A. S., Teber, D. & Rassweiler, J. Principles and initial experience of a new device for dissection and hemostasis. Minim. Invasive Ther. Allied Technol. 16, 58–65 (2007).
Frede, T. et al. Geometry of laparoscopic suturing and knotting techniques. J. Endourol. 13, 191–198 (1999).
Rassweiler, J., Frede, T., Teber, D. & van Velthoven, R. Laparoscopic radical cystectomy with and without orthotopic bladder replacement. Minim. Invasive Ther. Allied Technol. 14, 78–95 (2005).
Collins, J. W. & Wiklund, N. P. Totally intracorporeal robot-assisted radical cystectomy: optimizing total outcomes. BJU Int. 114, 326–333 (2014).
Tajima, M. et al. Safety and effectiveness of mechanical versus hand suturing of intestinal anastomoses in an animal model of peritonitis. Exp. Ther. Med. 4, 211–215 (2012).
Wagner, A. et al. Totally laparoscopic creation of a novel stapled orthotopic neobladder in the porcine model. J. Endourol. 22, 151–156 (2008).
Yoshikawa, T. et al. Laparoscopic esophagojejunostomy using the EndoStitch and a circular stapler under direct view created by the ENDOCAMELEON. Gastric Cancer 16, 609–614 (2013).
Rassweiler, J., Sentker, L., Seemann, O., Hatzinger, M. & Rumpelt, J. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J. Urol. 160, 201–208 (2001).
Pattaras, J. G., Smith, G. S., Landman, J. & Moore, R. G. Comparison and analysis of laparoscopic intracorporeal suturing devices: preliminary results. J. Endourol. 15, 187–192 (2001).
Göpel, T., Härtl, F., Schneider, A., Buss, M. & Feussner, H. Automation of a suturing device for minimally invasive surgery. Surg. Endosc. 25, 2100–2104 (2011).
Hart, S. The benefits of automated suturing devices in gynecologic endoscopic surgeries: the Endo Stitch and SILS Stitch. Surg. Technol. Int. 22, 159–164 (2012).
Chi, T., Eisner, B. H., Berger, A. D. & Stoller, M. An ex-vivo evaluation of the application and strength of a novel laparoscopic knot substitute device. J. Endourol. 24, 95–98 (2010).
Madan, A. K. et al. Evaluation of specialized laparoscopic suturing devices. JSLS 8, 191–193 (2004).
Jernigan, S. A laparoscopic knot-tying device for minimally invasive cardiac surgery. Eur. J. Cardiothorac. Surg. 37, 626–630 (2010).
Lee, C. Y., Sauer, J. S., Gorea, H. R., Martellaro, A. J. & Knight, P. A. Comparison of strength, consistency, and speed of COR-KNOT versus manually hand-tied knots in an ex vivo minimally invasive model. Innovations 9, 111–116 (2014).
Winder, J. S. & Pauli, E. M. Comprehensive management of full-thickness luminal defects: the next frontier of gastrointestinal endoscopy. World J. Gastrointest. Endosc. 10, 758–768 (2015).
Stowers, S. & Wright, R. A. Case study: surgeons surpass 500 cases using market's first curved needle suturing device. EndoEvolution [online], (2015).
Zondervan, P. J. et al. Partial nephrectomy: is there an advantage of self-retaining suture in the perioperative period? A matched case-control comparison. World J. Urol. 30, 659–664 (2012).
Greenberg, J. A. & Goldman, R. H. Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. Rev. Obstet. Gynecol. 6, 110–115 (2013).
Gözen, A. S., Tokas, T., Akin, Y., Klein, J. & Rassweiler, J. Impact of barbed suture in controlling the dorsal vein complex during laparosopic radical prostatectomy. Minim. Invasive Ther. Allied Technol. 27, 1–6 (2014).
Hart, S. & Sobolewski, C. J. The benefits using barbed sutures with automated suturing devices in gynecologic endoscopic surgeries. Surg. Technol. Int. 23, 161–165 (2013).
Brehmer, B. et al. Endosew: new device for laparoscopic running sutures. J. Endourol. 22, 307–311 (2008).
Roth, B., Birkhäuser, F. D., Thalmann, G. N. & Zehnder, P. Novel prototype sewing device, EndoSewR, for minimally invasive surgery: an extracorporeal construction pilot study in 10 patients. BJU Int. 112, 959–964 (2012).
Frede, T. et al. The Radius Surgical System — a new device for complex minimally invasive procedures in urology? Eur. Urol. 51, 1015–1022 (2007).
Tokas, T., Gözen, A. S., Tschada, A. & Rassweiler, J. A laparoscopic combination with comparable ergonomic results to robotic surgery, tested in an experimental laparoscopic radical prostatectomy setting [abstract PD18-11]. J. Urol. 193, e390 (2015).
White, W. M. et al. Single-port laparoscopic abdominal sacral colpopexy: initial experience and comparative outcomes. Urology 74, 1008–1012 (2009).
Janetschek, G. Robotics: will they give a kick to single-site surgery. Eur. Urol. 66, 1044–1045 (2014).
Albayrak, A. et al. A newly designed ergonomic body support for surgeons. Surg. Endosc. 21, 1835–1840 (2007).
Rassweiler, J. J. et al. A new platform improving the ergonomics of laparoscopic surgery: initial clinical evaluation of the prototype. Eur. Urol. 61, 226–229 (2012).
Gözen, A. S. et al. Comparison of operating positions and ETHOS surgical platform for laparoscopic pelvic surgery simulation. J. Endourol. 29, 95–99 (2015).
Jaspers, J. E. N., Bentala, M., Herder, J. L., De Mol, B. A. & Grimbergen, C. A. Mechanical manipulator for intuitive control of endoscopic instruments with seven degrees of freedom. Minim. Invasive Ther. Allied Technol. 13, 191–198 (2004).
Buess, G. F. et al. A new remote-controlled endoscope positioning system for endoscopic solo surgery. Surg. Endosc. 14, 417–418 (2000).
Kavoussi, L. R., Moore, R. G., Adams, J. B. & Partin, A. W. Comparison of robotic versus human laparoscopic camera control. J. Urol. 154, 2134–2136 (1995).
Rassweiler, J. et al. Telesurgery (eds Kumar, S. & Marescaux, J.) 67–89 (Springer, 2008).
Janetschek, G., Bartsch, G. & Kavoussi, L. R. Transcontinental interactive laparoscopic telesurgery between the United States and Europe. J. Urol. 160, 1413–1415 (1998).
den Boer, K. T. et al. Time-action analysis of instrument positioners in laparoscopic cholecystectomy. Surg. Endosc. 16, 142–147 (2002).
Wagner, A. A., Varkarakis, M., Link, R. E., Sullivan, W. & Su, L.-M. Comparison of surgical performance during laparoscopic radical prostatectomy of two robotic camera holders; EndoAssist and AESOP: a pilot study. Urology 68, 70–74 (2006).
Polet, R. & Donnez, J. Gynecologic laparoscopic surgery with a palm-controlled laparoscopic holder. J. Am. Assoc. Gynecol. Laparosc. 11, 73–78 (2004).
Hung, A. J. et al. Robotic transrectal ultrasonography during robot-assisted radical prostatectomy. Eur. Urol. 62, 341–348 (2012).
Gillen, S. et al. Solo-surgical laparoscopic cholecystectomy with a joystick-guided camera device: a case–control study. Surg. Endosc. 28, 164–170 (2014).
Jaspers, J. E., Den Boer, K. T., Sjoerdsma, W., Bruijn, M., Grimbergen, C. A. Design and feasibility of PASSIST, a passive instrument positioner. J. Laparoendosc. Adv. Surg. Tech. A 10, 331–335 (2000).
Micali, S. et al. New trends in minimally invasive urologic surgery: what is beyond the robot? World J. Urol. 31, 505–513 (2013).
Pini, G. & Rassweiler, J. Minilaparoscopy and laparoendoscopic single-site surgery: mini- and single-scar in urology. Minim. Invasive Ther. Allied Technol. 21, 8–25 (2012).
Rassweiler, J. et al. Role of laparoscopy in reconstructive surgery. Curr. Opin. Urol. 20, 471–482 (2012).
Pini, G. et al. Small-incision access retroperitoneoscopic technique (SMART) pyeloplasty in adult patients: comparison of cosmetic and postoperative pain outcomes in a matched-pair analysis with standard retroperitoneoscopic pyeloplasty: preliminary report. World J. Urol. 30, 605–611 (2012).
Porpiglia, F. et al. Contemporary urologic minilaparoscopy: indications, techniques and surgical outcomes in a multi-institutional European cohort. J. Endourol. 28, 951–957 (2014).
Georgiu, A. N. et al. Evolution and simplified terminology of natural orifice transluminal endoscopic surgery (NOTES), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy. World J. Urol. 30, 573–580 (2012).
Irvin, B. H., Rao, P. P., Stein, R. J. & Desai, M. M. Laparoendoscopic single site surgery in urology. Urol. Clin. North Am. 36, 223–235 (2009).
Dapri, G. Access devices for single-port laparoscopic surgery. EAES [online], (2015).
Haber, G. P. et al. Spider surgical system for urologic procedures with laparoendoscopic single-site surgery from initial laboratory experience to first clinical application. Eur. Urol. 61, 415–422 (2012).
Petroni, G. et al. A novel robotic system for single-port laparoscopic surgery: preliminary experience. Surg. Endosc. 27, 1032–1937 (2013).
Can, S. et al. The mechatronic support system 'HVSPS' and the way to NOTES. Minim. Invasive Ther. Allied Technol. 17, 341–345 (2008).
Herrell, S.D., Webster, R. & Simaan, N. Future robotic platforms in urologic surgery: recent developments. Curr. Opin. Urol. 24, 118–126 (2014).
Wortman, T. D., Mondry, J. M., Farritor, S. M. & Oleynikov, D. Single-site colectomy with miniature in vivo robotic platform. IEEE Trans. Biomed. Eng. 60, 926–929 (2013).
Kaouk, J. H. et al. A novel robotic system for single-port urologic surgery: first clinical investigation. Eur. Urol. 66, 1033–1043 (2014).
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.
Rights and permissions
About this article
Cite this article
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
This article is cited by
Utility of total cell-free DNA levels for surgical damage evaluation in patients with urological surgeries
Scientific Reports (2021)
Roboterassistierte Systeme der Zukunft
Robot-assisted flexible ureteroscopy: an update
Review of emerging surgical robotic technology
Surgical Endoscopy (2018)