Historical Perspective

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Endoscopic & Minimal Invasive Surgery Research Center
Mashhad University of Medical Sciences
Historical Perspective

The tenth century Arabian physician Abulkasim (936 - 1013) is credited with the first documented use of reflected light to view an internal body cavity. Although the procedure was successful, thermal injury from the light source limited the technique.
Improvements in optics in the latter half of the nineteenth century rekindled interest in the procedure. Around the turn of the nineteenth century, in Europe, particularly in Austria and Germany, many different centers were exploring endoscopy and laparoscopy. In 1869, Karl Stoerk , an Austrian laryngologist, inspected the esophagus of a patient with an instrument comprised of different jointed segments that could be straightened after insertion. In 1901, Georg Kelling, a German physician, coined the term “ celioscopy “ in describing his use of a cystoscope to examine the peritoneal cavity of a dog, utilizing insufflation with air. In 1910, Jacobaeus, a Swedish physician, reported the first use of celioscopy in humans, and in 1912, he published a 97 – patient series. The first reported use of laparoscopy in the United States occurred in 1911 when Bertram Bernheim of John Hopkins University performed “ organoscopy “ on two patients, one of which was a patient of W. S. Halstead, diagnosing localized pancreatic cancer, which was later confirmed at open laparotomy by Dr. Halstead.
Heinz Kalk built upon the work of Jacobeus and, in fact, opened a school for laparoscopy in Germany in the 1920s. He made a number of key advances including the introduction of the angled telescope as well as describing a multiport procedure for performing liver biopsies. The next major advance was made by Veress in 1938 with the development of a needle that was inserted into the abdominal cavity to induce pneumoperitoneum. It could be argued that it was the work of Kurt Semm, a gynecologist who introduced the automatic insufflator in the 1970s, that ushered in the modern era of laparoscopy.The ability to automatically regulate gas flow and abdominal pressure significantly reduced the incidence of bowel perforations as well as injury to other intra – abdominal and retroperitoneal structures. Semm developed a thermocoagulator to help reduce the injuries caused by unipolar cautery. He also developed the angled – lens scope and hook scissors to allow better visualization and manipulation of pelvic structures. With Hasson’s development of the “open “ technique of cannula insertion in the late 1970s, laparoscopy became a safe and effective procedure with innumerable applications. In fact, by 1984, Semm had performed over 14,000 laparoscopic procedures with an overall complication rate of 0.28%. Despite these advances, it was not until the introduction of the laparoscopic cholecystectomy firstly performed in 1988 independently by Mouret in France and McKernan and Saye in the United States that laparoscopic surgery gained widespread acceptance.