Zusammenfassung Aneurysmen der extrakraniellen Karotiden sind eine Rarität. Es werden echte Aneurysmen von Pseudoaneurysmen unterschieden. Eine pulsatile Schwellung im Halsbereich und/oder eine variable neurologische Symptomatik können diagnostisch wegweisend sein. Im Gefäßultraschall kann ein distales Aneurysma übersehen werden. Eine Diagnostik mittels CTA oder MRA ist zur Planung des Therapiemanagements unerlässlich. Die offen chirurgische Therapie ist die Methode der Wahl, sie besteht in der Resektion und anschließender Gefäßrekonstruktion oder in einer Patchplastik. Endovaskuläre Methoden sind heute noch Einzelfallentscheidungen.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have evolved rapidly from an antidiabetic drug class into one of the most influential pharmacological groups in internal medicine. The approved agents - semaglutide, liraglutide and the dual GIP/GLP-1 agonist tirzepatide - achieve weight reductions of up to 22% of body weight. The close pathophysiological link between obesity, metabolic syndrome and urological-andrological disease creates direct clinical relevance for urology.This narrative review summarises a systematic PubMed search (2020-2026) covering erectile dysfunction, hypogonadism, male fertility, nephroprotection, prostate cancer, lower urinary tract symptoms and perioperative considerations in the context of GLP-1 RA therapy. GLP-1 RAs show clinically relevant effects in several urological domains: increase in total testosterone and improvement in erectile function in men with obesity-related hypogonadism, nephroprotection with reduction of albuminuria and slowing of eGFR decline, signals of reduced prostate cancer risk in epidemiological studies, and indirect benefit for stress incontinence and overactive bladder via weight loss. At the same time, clinically relevant warning signals exist: a 4.5-fold increased risk of new-onset erectile dysfunction in non-diabetic obese men on semaglutide, novel urological adverse effects in case reports, perioperative aspiration risk through delayed gastric emptying, and a near-complete absence of data in women.GLP-1 RAs represent both a therapeutic opportunity and a clinical challenge for urologists. Systematic andrological and nephrological monitoring as well as proactive patient education on urogenital and perioperative implications is recommended. Prospective controlled trials with urological endpoints are needed.
Purpose Robot-assisted thoracic surgery (RATS) has emerged as an important extension of the minimally invasive thoracic surgical armamentarium. Currently, access to robotic platforms remains limited and unevenly distributed, resulting in considerable variability in training opportunities. This review aims to evaluate the current role of RATS in thoracic surgical education and to identify existing challenges and future perspectives. Patients/Materials and Methods A narrative review was conducted based on a contemporary literature search. Relevant international publications addressing the adoption of RATS, training concepts, learning curves, educational strategies, and the development of national and international curricula were reviewed and analysed. Results The available literature indicates that RATS provides several educational advantages, including highly standardised surgical workflows, superior visualisation, and direct teaching opportunities through dual-console systems. These features facilitate stepwise skills acquisition and have been associated with shorter learning curves compared with conventional approaches. Nevertheless, access to robotic systems in Germany remains restricted to a limited number of centres, resulting in substantial disparities in training exposure. Existing industry-supported training programs primarily target experienced surgeons, whereas structured, technology-independent curricula for residents and early-career surgeons are still limited. Supplementary educational formats such as simulation-based training, boot camps, wet labs, and cadaver laboratories may help bridge this gap and standardise competency acquisition. At the same time, increasing reliance on robotic techniques may contribute to a decline in proficiency in video-assisted thoracic surgery (VATS) and open procedures, which remain essential for managing complex cases and conversions. Conclusion RATS has considerable potential to enhance thoracic surgical training, effectively enhances thoracic surgical training and provides an effective environment to competency-based education. However, its successful integration into residency and fellowship programs requires widespread implementation of standardised curricula that combine robotic training with the preservation of conventional surgical skills. The introduction of the first German Society for Thoracic Surgery (DGT)-certified multi-level RATS curriculum in 2025 is an important milestone toward achieving this goal.
