SUNDAY, DAY 7
MEDICAL MILESTONES
The practice of laparoscopy began with looking inside the body using a long, lighted tube and mirrors. In the 20th century, however, doctors saw its potential for more active treatments and use in surgical procedures as well.
In 1910, the Swedish physician Hans Christian Jacobaeus (1879–1937) performed what are considered to have been the first laparoscopic surgeries: He used a cystoscope— a narrow tube inserted into the urethra to examine the bladder—to determine the cause of abdominal complaints in patients with tuberculosis. The Johns Hopkins Hospital in Baltimore soon reported on a similar procedure of its own, called organoscopy. In New York City in the 1950s, Albert Decker (1895–1988)introduced the culdoscope for viewing the female pelvis through the vaginal canal.
Some of the first tools to be utilized laparoscopically were spring-loaded needles used for pneumoperitoneum (filling the abdominal cavity with air for easier visibility and maneuvering during surgery) and forceps used for electrocoagulation of bleeding areas. In 1961, the French gynecologist Raoul Palmer (1904–1985) performed the first laparoscopic retrieval of a woman’s eggs for an attempt at in vitro fertilization. Around the same time, the German doctor Kurt Semm (1927–2003) performed the first appendectomy during a gynecologic procedure, without the need for a large incision in the abdomen. By 1970, gynecologists were routinely doing tubal ligation for sterilization by laparoscopy. In 1971, the New York gynecologist Bruce Young (1938–) introduced the umbilical incision for pelvic laparoscopy because a belly dancer requested that he leave no visible scar, and it was safer and easier to perform.
In the early 1970s, surgeons at Grant Hospital of Chicago standardized a technique for performing surgery through miniature incisions in the abdomen. This practice became widespread by the 1980s, especially after the introduction of video laparoscopy. The first laparoscopic cholecystectomy—removal of the gallbladder through four small abdominal incisions—was performed in 1987 in France. Today, gallbladder removal is the most common laparoscopic procedure performed, using scissors, graspers, and other tools only 5 to 10 millimeters in diameter. Because the gallbladder is like a small balloon, it can be sucked out of a 1-centimeter incision by first suctioning out the bile inside. Other procedures that can be done laparoscopically today include removal of the colon, kidney, and spleen; bariatric weight-loss surgery; and gynecologic and urologic surgery. Recovery time for these procedures is typically much less than for traditional surgery; sometimes patients can even leave the hospital the same day.