[Establishment of university departments of urology in North Rhine-Westphalia: the Aachen model]. / Etablierung von Urologischen Universitätskliniken in NRW : Das Aachener Modell.

The foundation of university departments of urology in postwar East and West Germany faced some opposition by some university professors of surgery who wanted to preserve the unity of their discipline. In North Rhine-Westphalia, heads of municipal hospitals or senior members of university hospitals' staff often received the first chaired professorships of urology.

[The early development of brachytherapy of the prostate: a study on technique application in the development of urology]. / Zur frühen Entwicklung der Brachytherapie der Prostata : Eine Studie zur Technikanwendung in der Urologieentwicklung.

Within recent years brachytherapy of the prostate has become a treatment of choice. The treatment can be dated back up to the beginning of the twentieth century. It is interesting that the urological routes have never been explored directly by authors of articles and textbooks in the field of radiology and radiooncology.

[Urology and National Socialism illustrated by the example of Leopold Casper (1859-1959)]. / Urologie und Nationalsozialismus am Beispiel von Leopold Casper (1859-1959).

Leopold Casper (1859-1959) was one of the founders of the German Urological Society (DGfU) in 1906. He introduced functional kidney testing and a special cystoscope for ureteral catheterization. In 1913 he was president of the 4th congress held in the German capital Berlin. His textbook on genito-urinary diseases was translated by Charles W. Bonney in 1910 and proved the high quality of his scientific work. As a Jew he was forced to leave Nazi Germany later on in 1933 and from 1941 onwards he lived in New York. The anniversary of his 150th birthday should be remembered with special focus on the exodus of Jewish German scientists during the Nazi period.

Transabdominal endoscopic computer-enhanced coronary artery bypass grafting.

BACKGROUND: Due to limited range of motion, endoscopic multivessel revascularization is difficult through a thoracic approach. METHODS: A computer-enhanced surgical telemanipulation system was used to perform transabdominal endoscopic grafting (TCAB) in an experimental cadaver model. After incising the membranous portion of the diaphragm, pericardium, and pleura, dissection of the left (n = 10) and right internal thoracic arteries (n = 5) was performed. Coronary anastomoses were performed remotely and unassisted. In an animal model the hemodynamic consequences of the approach were assessed. RESULTS: In all cadavers TCAB was achieved through three abdominal ports. Time for internal thoracic arteries harvest was 48+/-13 minutes (left) and 39+/-10 minutes (right). Intimal dissection was found in one graft. Time for anastomosis was 23+/-9 minutes and 27+/-10 minutes for the left anterior descending (n = 10) and right coronary artery (n = 5), respectively. All anastomoses were patent. Opening the diaphragm in living animals led to a decrease of systolic blood pressure by 30+/16 mm Hg, but resolved with appropriate treatment. CONCLUSIONS: TCAB is possible in cadavers using computer-enhanced telemanipulation technology. The transabdominal approach is a promising access for less invasive cardiac surgery.

Computer-assisted telemanipulation: an enabling technology for endoscopic coronary artery bypass.

BACKGROUND: The ultimate objective of minimally invasive coronary artery bypass grafting is to perform the anastomosis totally endoscopically. In this feasibility study, we examined the potential of performing coronary artery bypass grafting with the use of computer-assisted telemanipulation technology. METHODS: Intuitive Telemanipulation Technology (Intuitive Surgical, Mountain View, CA) was used to perform an arterial graft to left anterior descending coronary artery anastomosis in an ex vivo on-bench swine heart model. The degree of difficulty in performing the anastomosis, intraoperative events, duration of the anastomosis, and its quality were determined. RESULTS: Anastomosis was performed with relative facility, in a range of 10.7 to 17.4 minutes (mean +/- standard deviation, 14.6 +/- 2.6 minutes). All anastomoses were patent and of good quality except one, which had 30% narrowing of its heel. CONCLUSIONS: We conclude that Intuitive Telemanipulation Technology may in the future permit the performance of quality totally endoscopic coronary artery anastomosis with facility and acceptable time.

Gasless laparoscopy using a planar lifting technique.

In clinical use, the mechanical lifting technique has demonstrated the ability to displace the abdominal wall and create a useful cavity for visualization and surgical manipulation. By forming a planar ceiling, as opposed to the domed ceiling of conventional pneumoperitoneum, the abdominal organs are brought into closer proximity of the surgeon. Instrument length may be shortened, imparting greater surgical control. Without the necessity for gas sealing, entry portals are simplified. Conventional instruments (right angle clamps) may be introduced through the fan retractor insertion sites or by way of separate stab incisions. The planar lifting technique has the potential for simplifying laparoscopy and restoring instrument control to the operating surgeon.

Novel technique and instrumentation for laparoscopic application of hemostatic clips.

A novel device for applying hemostatic clips in laparoscopic surgery incorporates a distal hook into a multiple-firing titanium clip applier. The hook may be used for blunt dissection of tissue, and to displace and control ducts and vessels during clip application. A single instrument may be used to achieve hemostasis in areas that are difficult to reach, and past pointing problems encountered with straight on clip appliers are alleviated. Comparative testing of the holding force of the curved clips used with this device versus the straight clips used in conventional multiple-clip appliers demonstrated a higher mean pull-off force of 0.473 lbs versus 0.33 lbs. Clinical application of the device in laparoscopic procedures including cholecystectomy, vaginal hysterectomy, Nissen fundoplication, vagotomy, varicocelectomy, and lymphadenectomy show the utility of the hook clip applier.