Textbook of Practical Laparoscopic Surgery RK Mishra
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1Essentials of Laparoscopy
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Chronological Advances in Minimal Access SurgeryCHAPTER 1

The earliest recorded references to endoscopy date to ancient times with Hippocrates. In his description there is explanation of rectum examination with a speculum. Hippocrates advised injecting a large quantity of air into the intestines through the anus in intestinal obstruction. He advocated the insertion of suppository that was 10 digits long. These descriptions suggest that Hippocrates was well aware of ileus with intestinal obstruction and thought that there were several possible etiologies, including fecal impaction, intussusceptions, and sigmoid volvulus. Moreover, Hippocrates treated these life-threatening conditions with minimally invasive approaches.
1585
Aranzi was the first to use a light source for an endoscopic procedure, focusing sunlight through a flask of water and projecting the light into the nasal cavity.
1706
The term “trocar,” was coined in 1706, and is thought to be derived from “trochartor” troise-quarts, a three-faced instrument consisting of a perforator enclosed in a metal cannula.
1806
Philip Bozzini, built an instrument that could be introduced in the human body to visualize the internal organs. He called this instrument “LICHTLEITER”. Bozzini used an aluminum tube to visualize the genitourinary tract. The tube, illuminated by a wax candle, had fitted mirrors to reflect images (Fig. 1.1).
1853
Antoine Jean Desormeaux, a French surgeon first introduced the “Lichtleiter” of Bozzini to a patient. For many surgeons, he is considered as the “Father of Endoscopy”.
1867
Desormeaux, used an open tube to examine the genitourinary tract, combining alcohol and turpentine with a flame in order to generate a brighter, more condensable beam of light.
1868
Kussmaul performed the first esophagogastroscopy on a professional sword swallower, initiating efforts at instrumentation of the gastrointestinal tract. Mikulicz and Schindler, however, are credited with the advancement of gastroscopy.
1869
Commander Pantaleoni used a modified cystoscope to cauterize a hemorrhagic uterine growth. Pantaleoni thus performed the first diagnostic and therapeutic hysteroscopy.
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Fig. 1.1: Lichtleiter's endoscope
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1901
Dimitri Ott, a Petrograd gynecologist used head mirrors to reflect light and augment visualization and used access technique in which a speculum was introduced through an incision in the prior vaginal fornix in a pregnant woman.
1901
The first experimental laparoscopy was performed in Berlin in 1901 by the German surgeon Georg Kelling, who used a cystoscope to peer into the abdomen of a dog after first insufflating it with air. Kelling also used filtered atmospheric air to create a pneumoperitoneum, with the goal of stopping intra-abdominal bleeding (Ectopic pregnancy, bleeding ulcers, and pancreatitis) but these studies did not find any response or supporters (Fig. 1.2).
Kelling proposed a high-pressure insufflation of the abdominal cavity, a technique he called the “Luft-tamponade” or “air-tamponade”.
1910
HC Jacobaeus of Stockholm published a paper on discussion of the inspection of the peritoneal, pleural and pericardial cavity.
1911
Bertram M Bernheim of Johns Hopkins Hospital introduced first laparoscopic surgery to the United States. He named it the procedure of minimal access surgery as “organoscopy”. Theinstrument used was a proctoscope of a half inch diameter and ordinary light for illumination was used.
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Fig. 1.2: Kelling performing laparoscopy in dog
1911
HC Jacobaeus coined the term “laparothorakoskopie” after using this procedure on the thorax and abdomen. He used to introduce the trocar inside the body cavity directly without employing a pneumoperitoneum.
1918
O Goetze developed an automatic pneumoperitoneum needle characterized for its safe introduction to the peritoneal cavity.
The next decade and a half witnessed a decline in technological advancement in endoscopy due to World War I.
1920
Zollikofer of Switzerland discovered the benefit of CO2 gas to use for insufflation, rather than filtered atmospheric air or nitrogen.
1929
Kalk, a German physician, introduced the forward oblique (135°) view lens systems. He advocated the use of a separate puncture site for pneumoperitoneum. Goetze of Germanyfirst developed a needle for insufflation.
1929
Heinz Kalk, a German gastroenterologist developed a 135° lens system and a dual trocar approach. He used laparoscopy as a diagnostic method for liver and gallbladder diseases (Fig. 1.3).
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Fig. 1.3: Heinz Kalk
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1934
John C Ruddock, an American surgeon described laparoscopy as a good diagnostic method, many times, superior than laparotomy. He used the instrument for diagnostic laparoscopy which consisted of built-in forceps with electrocoagulation capacity (Fig. 1.4).
1936
Boesch of Switzerland is credited with the first laparoscopic tubal sterilization.
1938
Janos Veress of Hungary developed a especially designed spring-loaded needle. Interestingly, he did not promote the use of his Veress needle for laparoscopy purposes. He used Veress needle for the induction of pneumothorax. Veress needle is widely used instrument today to create pneumo-peritoneum (Fig. 1.5).
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Fig. 1.4: John Ruddock
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Fig. 1.5: Veress needle
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Fig. 1.6: Laparoscope
1939
Richard W Telinde, tried to perform an endoscopic procedure by a culdoscopic approach, in the lithotomy position. This method was rapidly abandoned because of the presence of small intestine.
1939
Heinz Kalk published his experience of over 2000 liver biopsies, performed using local anesthesia without mortality.
1944
Raoul Palmer, of Paris performed gynecological examinations using laparoscopy, (Fig. 1.6) and placing the patients in the Trendelenburg's position, so air could fill the pelvis. He also stressed the importance of continuous intra-abdominal pressure monitoring during a laparoscopic procedure.
1953
The rigid rod lens system was discovered by Professor Hopkins. The credit of videoscopic surgery goes to this surgeon who had revolutionized the concept by making this instrument.
1960
Kurt Semm was a German gynecologist, who invented the automatic insufflator (Fig. 1.7). His experience with this new device was published in 1966. Though not recognized in his own country, but on the other side of the Atlantic, both American physicians and instrument makers valued the Semm's insufflator for its simple application, clinical value, and safety (Fig. 1.8).
1960
Patrick Steptoe, a British gynecologist adapted the techniques of sterilization by two puncture technique.
1972
H Coutnay Clarke showed laparoscopic suturing technique for hemostasis.
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Fig. 1.7: Kurt Semm
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Fig. 1.8: First insufflator made by Prof Semm
1973
Gaylord D Alexander, developed techniques of safe local and general anesthesia suitable for laparoscopy.
1977
First laparoscopic assisted appendicectomy was performed by Dekok. Appendix was exteriorized and ligated outside the abdominal cavity.
1977
Kurt Semm demonstrated endoloop suturing technique in laparoscopic surgery.
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Fig. 1.9: Hasson's cannula
1978
Hasson introduced an alternative method of blunt trocar placement. He proposed a blunt mini-laparotomy which permits direct visualization of trocar entrance into the peritoneal cavity.
Hasson's cannula was a reusable device of similar design to a standard cannula but attached to an olive-shaped sleeve was developed. This sleeve would slide up and down over the shaft of the cannula and form an airtight seal at the fascial opening. In addition, the sharp trocar was replaced by a blunt obturator. This cannula is held in place by the use of stay sutures passed through the fascial edges and attached to the body of the cannula (Fig. 1.9).
1980
Patrick Steptoe started to perform laparoscopic procedures first time in UK.
1983
Semm, German gynecologist, performed the first laparoscopic appendicectomy.
1985
The first documented laparoscopic cholecystectomy was performed by Erich Mühe in Germany in 1985.
1987
Phillipe Mouret has got the credit to perform the first laparoscopic cholecystectomy in Lyons, France using video technique (Fig. 1.10). Cholecystectomy is the laparoscopic procedure which revolutionized the general surgery.
1987
Ger reported first laparoscopic repair of inguinal hernia using prototype stapler.
1987
Complete removal of gallbladder was performed by Mouret in Lyon, France.
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Fig. 1.10: Phillipe Mouret
1988
Harry Reich performed laparoscopic lymphadenectomy for treatment of ovarian cancer.
1988
McKernan and Sye performed first cholecystectomy in the USA (Fig. 1.11).
1989
Harry Reich described first laparoscopic hysterectomy using bipolar desiccation; later he demonstrated staples and finally sutures for laparoscopic hysterectomy.
1989
Reddick and Olsen reported that CBD injury after laparoscopic cholecystectomy is 5 times than with conventional cholecystectomy. As a result of this report, USA government announced, that surgeons should perform at least 15 laparoscopic cholecystectomy under supervision, before being allowed to do this procedure on their own.
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Fig. 1.11: William Sye
1990
Bailey and Zucker in USA popularized laparoscopic anterior highly selective vagotomy combined with posterior truncal vagotomy.
1994
First robotic arm was designed to hold the telescope with the goal of improving safety and reducing the need of skilled camera operator (Fig. 1.12).
1996
First live telecast of laparoscopic surgery performed remotely via the Internet (Robotic Telesurgery).
2000
The US Food and Drug Administration (FDA) first time approved the da Vinci Surgical System, making it the first robotic system allowed to be used in American operating rooms.
2001
The Lindbergh operation, named in honor of American aviator Charles Lindbergh, was the first ever transatlantic surgery. Doctors Michel Gagner and Jacques Marescaux removed the gall bladder of a 68-year-old woman in Strasbourg, France from New York. The surgeons used a ZEUS robotic surgical system from Computermotion Inc. and an ATM fiberoptic connection provided by France Télécom.
2004
Robotic prostatectomy became the first most commonly performed robotic surgery. According to Intuitive Surgical Inc., the California-based manufacturers of the da Vinci robot, the number of robotic prostatectomies rose from 36 in 2000 to 8000 in 2004.
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Fig. 1.12: Robotic arm
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2005
Combining robotically assisted coronary artery bypass surgery (CABG) with stented angioplasty shows promise for treating extensive coronary artery disease, researchers reported at the American Heart Association Scientific Sessions 2005, Dallas.
The evolution of minimal access therapy aims to minimize the traumatic insult to the patient without compromising the safety and efficacy of the treatment compared with traditional open surgery. If this is achieved, patients recover more quickly, which reduces hospital stay and allows more rapid return to full activity and work within minimum time.
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