Historical Aspects of Laparoscopic Surgery
Since the end of the last century, open urological surgery largely replaces by minimally invasive surgeries and procedures. Which achieves thanks to the continuous improvement of video-endoscopic technology. And the development of new instruments, with the implementation of physical principles and the introduction of robot-assisted surgery. Laparoscopic Trainer.
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Development Of the Technologies
In this review, the development of the technologies summarizes. The role of laparoscopy in specific urologic surgeries s discusses, and the future of minimally invasive surgery in urology speculates. Laparoscopic Trainer.
The development of laparoscopy as a minimally invasive technique is the result of successive. And progressive events since the time of Hippocrates, almost 500 years before Christ. The word laparoscopy comes from the combination of the Greek root words (lápara) and (scope). Which means abdomen and to observe, respectively; that is, (to look inside the abdomen).
Since ancient times and in different civilizations, interest expresses in exploring body cavities through natural orifices. With basic instruments that had this purpose. There are records in Babylonian manuscripts about the use of these instruments and mirrors. That reflected natural light, to make explorations through the anus or vagina.
However, the first clear description of the use of these instruments attributes to the Spanish surgeon of Arab origin Abacaxis (Abu-al-Qassim-al-Zahrawi, 936-1013 AD). It was he who first described their use of them to explore the cervix. The development of these instruments remained at a basic level for almost another 700 years. Laparoscopic Trainer.
Invented Light Conductor
At the dawn of the industrial revolution, a German doctor invented the (Lechleiter) or (light conductor). It consisted of an optic with a candlelight source. In a cadaveric model, he performed bladder scans and explored the abdominal cavity through wounds caused by trauma.
The scientific and religious skepticism of his colleagues, added to the rudimentary nature of the instrument, prevented his development. Light driver by Phillipe. The light source was a candle.
Optical System and The Light Source
Almost 40 years later, in 1853, the French urologist Antonin Jean Desormeaux improved the optical system and the light source. Created the first (endoscope), an instrument that allowed him to perform therapeutic interventions through the urethra treating strictures, papillomata, and gonorrhea. Laparoscopic Trainer.
Thanks to his interventions and taking advantage of the discovery of the anesthetic effects of chloroform, Desormeaux consider the father of endoscopic surgery. Mainly in Europe, improvements to endoscopic instruments took place, being able to broaden the range of therapeutic procedures.
Another urologist 1879, Maximilian Nitze, used magnifying lenses and incorporated them into the tip of the instrument. The electric focus was previously discovered by Thomas Alva Edison. In this period, thanks to the work of Nitze, one of the greatest advances in endoscopy took place. Laparoscopic Trainer.
In the early 1900s, the Russian gynecologist Dimitri von Ott used the Nitze endoscope through a small abdominal incision, laying the foundations for gynecological laparoscopy.
Previously, Georg, a German internist, had used a manual insufflator to suppress intraluminal digestive bleeding. And then, looking for less morbidity than a laparotomy, focused his interest on intraperitoneal bleeding. Uniting existing technologies, was the first to establish a field of work for laparoscopy addressing the inflated abdomen. Laparoscopic Trainer.
And with at least two other accesses to control intraperitoneal bleeding. In parallel, the internist, Hans Christian reported in 1910 his experience in laparoscopy to treat tuberculous ascites. Being both internists, they were not interested in other applications for their new technique.
Manual Insufflator to Perform Pneumoperitoneum
In the 1920s, studies were published regarding the effects of the absorption of insufflated air in the peritoneal cavity. And the Hungarian gynecologist Janos Veress invented a needle with an obturator that covered the bevel. Therefore, minimizing the possibility of causing damage to the viscera. When entering the abdomen perform the pneumoperitoneum. This needle uses routinely in laparoscopic surgeries today.
Refinement Of Endoscopes
With the development of insufflators, the recognition of the benefits of using carbon dioxide over ambient air was associated. Also, with the refinement of endoscopes. The popularity of diagnostic laparoscopy grew. In those years, gynecologists took the lead. By performing therapeutic procedures, but limited by using a single puncture.
Two events revolutionized images in laparoscopy.
- The first was the refinement of the optical lens by a British physicist,
- Professor Harold H. Hopkins; and
- The second was the incorporation of the cold light transmission system through the stem of the lens
by a German dedicated to the development of surgical instruments, Karl Storz.
Karl Storz And His Cold Light Source
In the mid-1960s, the German gynecologist Kurt, with his device for automatic CO2 insufflation. After recording of gas flow and intra-abdominal pressure. And associated the inventions described above, caused gynecological laparoscopy to have a worldwide boom. Even in the US, until then had almost given up the technique. Laparoscopic Trainer.
Assisting In Video-Laparoscopy
Video-laparoscopy creates by adding a camera to the rigid endoscope, now allowing the entire surgical team to participate in assisting the laparoscopic surgeon. With this, surgery was (democratized) in the pavilion, all those present could see, give their opinion and attend. As well as learning directly from the experience of expert surgeons.
Main improvements to endoscopic instruments took place, being able to broaden the range of therapeutic procedures. Therefore, minimizing the possibility of causing damage to the viscera. When entering the abdomen perform the pneumoperitoneum. Also learning directly from the experience of expert surgeons.
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