Pre-operative and New-Visualization Technique for Urology Practice

pre-operative-and-new-visualization-technique-for-urology-practice

Urology is a specialty medical stream which has been always at the forefront of research and innovation. Medical and healthcare segment is ever evolving field hence; no wonder if there are newer technologies put to practice. These technologies have been rapidly embraced and, in many cases, improved upon in order to achieve better patient outcomes. That’s the reason; Urology too is embracing such new visualization techniques which come equipped with technological advances. The role to further to reduce the urolithiasis treatment, robotic surgery and other minimally invasive techniques is addressed. The potentials for enhanced imaging and diagnostic techniques like magnetic resonance imaging and ultrasonography modifications, as well as the potential applications of nanotechnology and tissue engineering, are reviewed.

Since the description of the first laparoscopic nephrectomy in 1991, there has been a continual effort to enhance outcomes and introduce newer, less invasive approaches. This has been accomplished through laparoendoscopic approaches which encompass a wide array of surgical interventions, including robotic surgery, laparoendoscopic single-site surgery (LESS), and natural orifice transluminal surgery. The aim of this review is to highlight the major conceptual advancements in this field regardless of both the specific surgical approaches, whether pure laparoscopic or robotic, and the specific organ or pathology treated.

With the advancement in the technology like discussed earlier, there are many benefits of pre-operative and new visualization technologies in urology include:

  • Robot assisted laparoscopy
  • Endourology
  • Needle biopsy and focal prostate cancer treatment

The current available technologies to assist urologists in preoperative planning include fluoroscopy, CT and MRI. Unfortunately, these modalities have significant limitations. For fluoroscopy – it is limited in its accuracy, and has handling problems, CT – has its inherent radiation exposure issues, and MRI is expensive and has handling issues. One of these new and enhanced navigation techniques includes the utilization of 3D-CT simulation, which would be very helpful in preoperative planning. There has also been development of marker based navigation using the IPAD in kidney surgery.

As critical surfaces as well as surgical targets often lie subsurface, a range of techniques e.g. ultrasound and near-infrared imaging and registration methods have been investigated as robotic surgery gains popularity. While investigation of nerves, blood vessels, and tumors has received prior attention, there is been new prototype system for real-time multimodal image registration that focuses on the visualization of the urinary tract. By providing an accurate registration between stereo video images and a near infrared imager, it aims to enhance surgical awareness and make critical ureter tasks such as mobilization of the ureters easier.

Urology has long been recognized as an avid adopter of new technologies and innovations in surgical practice. In concert with the exponential and rapid improvements in laparoscopic techniques and instrumentations over the last two decades, urologists’ enthusiasm to implement minimally invasive approaches has led to the near extinction of open surgical approaches in several different urological diseases. This captivation was driven mainly by the morbidity associated with classic open approaches and the real benefits of less invasive approaches.

 Robot-assisted approaches in urology have fostered significant advances in minimally invasive surgery and in some instances completely replaced previously performed standard open procedures such as robotic prostatectomy and laparoscopic live-donor nephrectomies.

Although; efforts continue to explore newer, less invasive technologies and procedures, their widespread implementation will depend on the introduction of newer instrumentation’s that facilitate these surgeries. In order to prove the clinical utility of these newly described technologies and their equivalent therapeutic benefits compared with conventional laparoscopy, there is a strong need to have an objective and stringent evaluation of its clinical outcome.

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