1910

Laparoscopic Surgery

Hans Christian Jacobaeus (1879–1937)

For hundreds of years, the process of surgery was pretty straightforward. A surgeon uses a scalpel to cut open a big hole in the patient—big enough so the surgeon has a clear field of view and room to fit his or her hands. The procedure is performed, and then the hole is sewn up.

The problem is that big holes in people create a lot of side effects. They may get infected. They cause more pain. Surgeons may need to cut through a significant amount of muscle. They take a long time to heal. They leave big scars. Recovery times increase. So doctors, scientists, and engineers contemplated the idea of reducing the size of the hole. Laparoscopic surgery is the result of this thinking. In 1910, Swedish internist Hans Christian Jacobaeus performed the first thorascopic diagnosis using a cytoscope—a complete reconceptualization of the surgical process. Although laparoscopic surgery cannot replace all types of operations, when it can be used, it eliminates the big hole and all of the problems that go with it.

The fundamental idea at the core of laparoscopic surgery is to eliminate the surgeon’s need to directly see and directly touch the site of the operation. This means that several small holes (e.g., 1 cm or smaller) are cut in the patient. Two of the holes allow long, small, remotely operated tools to be inserted. One allows the insertion of a small camera and light. And one allows gas to flow in to keep the abdominal wall inflated and away from the surgical site. These small holes heal much more quickly than a single big hole would.

The surgeon now sees everything on a video monitor and does the entire procedure with long, small tools. There are gripping tools, cutting tools, and sewing tools that the surgeon inserts through the ports. She manipulates the tools with a scissor-like grip.

Laparoscopic surgery is a great example of how scientists and engineers can look at a problem and then find completely new ways of doing things that are significantly better than the obvious or traditional approach. When it happens, the new solution is often quite unexpected. Without developments such as this, refined medical processes such as the implantation of an artificial heart would not be possible.

SEE ALSO Defibrillator (1899), CT Scan (1971), MRI (1977), Artificial Heart (1982), Surgical Robot (1984).

Gastric bypass surgery being performed in a hospital.