الفهرس 
IMAGE-FUSION, AUGMENTED REALITY AND PREDICTIVE SURGICAL NAVIGATIONOnly 14 pages are availabe for public view
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Abstract
It is obvious that some of the new technologies mentioned here are still evolving, and it will be a while before they undergo clinical trials that establish their position in clinical medicine. A final word could be said about technologies reviewed in this essay.
Computer-aided imaging technology gives logical information to improve presurgical planning, intraoperative guidance, or predictive surgical navigation, to increase the accuracy of the expert surgeon as well as to decrease the learning curve of the novice. Intraoperative navigation can lead the surgeon to reduce redundant surgical acts, thus decreasing surgical errors and shortening operating time.
The idea and promise of NOTES are revolutionary, but its maturation and widespread application will likely evolve slowly and with an uncertain fate. The major proposed justifications for NOTES are scarless surgery and a reduction of discomfort and wall trauma.
The field of flexible robotics appears to be promising and there may be a natural evolution from existing platforms for flexible videoendoscopy. With improved precision, better ergonomics and reduced occupational radiation exposure, such technology could change the way we perform endoscopy today. Refinements in software and hardware could potentially allow these systems to be used for natural orifice transluminal surgery or single-port laparoscopic surgery in the future.
Although the standard of care for most urologic malignancies continues to be surgical excision, ablation, in the form of needle-based or extracorporeal approaches, is quickly establishing itself as a viable primary treatment option. If there is anything to be learned from the pioneering studies that have been reviewed here, it is that there must be strict adherence to inclusion criteria for patient enrollment and that there are real limitations with each approach.
Lasers have become well established in urology, particularly in the treatment of urolithiasis and BPH such that laser use in these areas is becoming standard, accepted practice. Laparoscopic applications continue to be examined but remain unproved at this time. Laser LPN aims to provide a bloodless knife for excision of renal masses; however, hemostasis and smoke generation remain problematic. Although laser RARP seems feasible, further long-term assessments are required. It is likely that laser energy will continue to be increasingly developed and used in urology.
Tissue engineering techniques require a cell culture facility designed for human application. Personnel who have mastered the techniques of cell harvest, culture, and expansion in addition to polymer design are essential for the successful application of this technology. Before these engineering techniques can be applied to humans, further studies need to be performed in many of the tissues described. Recent progress suggests that engineered urologic tissues and cell therapy may have clinical applicability.
Collaborations with biomedical engineers and radiologists have provided a rich opportunity to explore and expand optical technology and imaging techniques for intraoperative use during urologic surgery. As various imaging and tissue characterization modalities continue to evolve and refine, the surgeons of tomorrow will have a number of tools at their disposal to improve intra-operative surgical decision-making.
A variety of bioadhesives, tissue sealants, and hemostatic agents are available to surgeons today. This has allowed for a dramatic growth in the fields of laparoscopic and reconstructive urology with less morbidity and increased success. Currently, there is no perfect agent that is able to perform well in all surgical applications. Many agents are used in combination, and although this practice is clinically effective it limits the ability to ditinguish the optimal properties of each agent. A thorough knowledge of the safety, efficacy, cost, and biologic properties of these agents can help a surgeon select a product best suited to fit their needs, but individual operative experience remains a critical factor in determining successful outcomes.