“The measure of intelligence is the ability to change” -Albert Einstein

One of the biggest changes in the world of surgery in the evolutionary shift of open surgeries to laparoscopic ones. Laparoscopy has revolutionalised the life of gynaecologists too.

The historical prospective goes back to ancient times,the easily accessible body parts were inspected by the help of speculums. The first description dates to Hippocrates in Greece, for use of a speculum to visualize the rectum (460–375 BC).

The word ENDOSCOPY was inherited from GREEK meaning… ‘To Examine Within’.  From the Babylonian Talmud.The term endoscopy was first used between 980 and 1037 AD by Aricenna. The treatise describes a lead funnel inserted into the vagina for inspection of the vagina.

A triple armed vaginal mirror and a rectal speculum was found in the ruins of Pompeii (A roman town buried by a volcano eruption near modern Naples, Italy – 79 AD).

The Arab Abu al QasimKhalaf is regarded as the middle ages most eminent surgeon to use a glass mirror to reflect the light in vagina.

In 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.

Philip Bozzini who marks the turning point from the old to new medicine must be mentioned for his contributions to the development of  modern endoscopy.In 1806, built an instrument that could be introduced in the human body to visualize the internal organs. He called this instrument “LICHTLEITER”. Bozzini used an aluminium tube to visualize the genitourinary tract. The tube, illuminated by a wax candle, had fitted mirrors to reflect images. His principle of using an artificial light source to reflect light and redirect it to the observer’s eye substantially influenced the international discussion on the development of endoscopes.

 In the 1865, the first serviceableportable  endoscope was presented by Desormeaux, nearly 50 years after Bozzini. His instrument was a system of mirrors and lenses with an open flame as light source. Skin burns were most frequent complication.

In 1869, Panteleoni of Ireland manage to visualize the uterine cavity of a woman using a cystoscope.

Gynaecology was to say the initiator of the development of operative endoscopy. Apart from Desormeaux and Panteleoni must also be mentioned for their attempts to inspect the uterine cavity i.e. today’s hysteroscopy.

In 1879 , Max Nitze used lens to magnify the area to be illuminated. This is the fore runner of the optical system of the modern endoscopy. Nitze is called “The Father of Modern Endoscopy ”. In 1887, he modified Edison`s light bulb and created the first electrical light bulb for use during urological procedures.

During the 19th century, lenses, light sources, and endoscopes evolved, and surgeons and internists performed cystoscopy, proctoscopy, laryngoscopy, and esophagogastroscopy.

Between 1890 – 1900 the German surgeon ,George Kelling did the 1st Experimental Laparoscopy. He insufflated air into the abdomen of a dog and used pneumoperitoneum and a cyctoscope on dog  inventing the technique of “celioscopy”. The brilliant idea of connecting  his air insufflations apparatus to the Fiedler trocar and Nitzecystoscope led to the birth of Laparoscopy.

 In1910, Jacobaeus of Sweden was the first to introduce the pneumoperitoneum and adoption of Trendelenburg position, trocar and cannula.

 In 1911, H.C. Jacobaeus, again coined the term “laparothorakoskopie” after using the procedure on the thorax and abdomen for the first time.. He used to introduce the trocar inside the body cavity directly without employing a pneumoperitoneum.

In 1929, Kalk, a German physician, introduced the forward oblique (135 degree) view lens systems. He advocated the use of a separate puncture site for pneumoperitoneum

Heinz Kalk, developed a superior laparoscope with improved lenses and the first forward-viewing scope in 1929, earning him the title “Father of Modern Laparoscopy”. Kalk pioneered in many diagnostic techniques, including a safe technique for laparoscopic liver biopsy.

Constant improvements in the laparoscopic methodology smoothed the way for its wider operative use.important steps were: the use of carbondioxide for pneumoperitoneumby  Zollikofer of Switzerland (1924), the coagulation of adhesions by Fervers in Germany (1933) and the intra abdominal use of monopolar current by Ruddock in USA (1934)

 In 1936, Boesch of Switzerland is credited for doing the first laparoscopic tubal sterilization  by electrocoagulation of the fallopian tubes. These breakthroughs paved the way for operative laparoscopy, but progress was very slow. By 1971, 35 years after Boesch’s breakthrough, only 1% of sterilizations in the United States were performed laparoscopically by surgeons like Dr. Karl Levinson, a former Society of Laparoendoscopic Surgeons (SLS) president.

In 1938, Janos Veress of Hungary developed a specially designed spring-loaded needle. Interestingly, Veress did not promote the use of his Veress needle for laparoscopy purposes. He used veress needle for the induction of pneumothorax.

In the 60s of the 20thcentury , gynaecologists began with the first small operative interventions. However the French gynaecologist Roaul Palmer in 1947 , published his first 250 cases in which he used the lithotomy Trendelenburg position. He also carried out the first laparoscopic sterilisation in Paris. The piercing of the umbilicus for the laparoscope by Palmer in 1946  was a groundbreaking procedure in gynecology.

In 1953, The rigid rod lens system was discovered by Professor Hopkins. The credit of videoscopic surgery goes to this surgeon who has revolutionized the concept by making this instrument. First Video Camera used by Dr Cameron Nehzat.

During the mid-1960s and 1970s, gynecologist Kurt Semm in Kiel, Engineer and Gynecologist Germany, contributed greatly to laparoscopic technology.

In 1965, he  introduced an automatic insufflation device capable of monitoring intra-abdominal pressures. This reduced the dangers associated with insufflation of the abdomen and allowed safer laparoscopy

In 1966, Kurt Semm German, introduced thermocoagulation, loop knots, irrigation device and performed endoscopic appendectomy as part of a gynecologicprocedure. In 1970, after becoming the chairman of Ob/Gyn at the University of Kiel, his co-workers demanded that he should undergo a brain scan because, they said , “ Only a person with brain damage would perform laparoscopic surgery ”

In 1968, Fragenheim noticed ovulation through laparoscope. In 1970 , Gynaecologists had embraced laparoscopy and thoroughly incorporated the technique into their practice…!!! General surgeons, despite their exposure to laparoscopy remained confined to  traditional open surgery…!!!

1971, gynecologist and SLS past president HarrithHasson contributed to the safety of laparoscopy, developing the Hasson trocar with the open entry technique.

In 1972, H.Coutnay Clarke first time showed laparoscopic suturing technique for hemostasis. In 1978, Hasson introduced an alternative method of trocar placement. He proposed a blunt mini-laparotomy which permits direct visualization of trocar entrance into the peritoneal cavity

In 1978 , Laparoscopy reached the zenith of glory when refined techniques described by Steptoe and Edwards for ovum retrieval, eventually resulted in embryo transfer and birth of a normal living child, Louise Joy Brown

In 1988, Harry Reich performed laparoscopic lymphadenectomy for treatment of ovarian cancer. In 1989, Harry Reich described first laparoscopic hysterectomy using bipolar desiccation; later he demonstrated staples and finally sutures for laparoscopic hysterectomy.

In 1994, FDA approved Robotic surgical device called AESOP (Automatic Endoscopic System for Optimal Positioning. Computer motion, Inc.). The da Vinci Robotic Surgical System and Zeus Robotic Surgical System.

By 1975 a huge heated debate had been brewing about whether or not the removal of ectopic pregnancies was indicated for laparoscopy and also tubal ligation by laparoscopy. Apparently there were some unexpected complications rates with the earliest procedures. As a result, laparoscopy was the target of intense scrutiny in the 1980s. The 1980s represent what are arguably the most controversial years in laparoscopy’s entire history.

Minimal access surgery has developed rapidly only after Grand success of laparoscopic cholecystectomy in 1987. In 1989, The 2nd International conference for endoscopic surgery, held in Atlanta, was described as a boat-rocking success and represented the moment in which, finally, General Surgeons became convinced of operative laparoscopy as the future of surgery…!!!

It took 5 years before Dr.CamranNezhat was able to present his laparoscopic treatment of extensive endometriosis in 1985. This was at the combined Canadian and American Fertility Society in Toronto, Canada. His paper was finally published in 1986 in Fertility and Sterility. At that time he reported laparoscopic treatment of Stage IV Endometriosis…Before the introduction of laparoscopic cholecystectomy, Gynecologists were performing most of the advanced laparoscopic procedures. For example, in 1985, ’86 and ’89, Dr.CamranNezhat and his colleagues reported laparoscopic treatment of Stage IV Endometriosis involving the bowel, bladder and ureters which he had been routinely performing for years.

Nezhat and colleagues, in this country, and Cainis in Clearmont, France, first reported Radical hysterectomy in the late 1980s and early 1990s. M.A. Pelosi introduced novel laparoscopic techniques of Single port laparoscopy. GA Vilos advanced Hysteroscopic techniques. Jacques Donnez and Hasson performed one of the first laparoscopic Supracervical hysterectomies.

Dazzling technological advances took center stage during this era of 1990s… The First Laparoscopic Robotic procedures were performed by T. Falcone, J. Goldberg, A. Garcia-Ruiz, H. Margossian, L. Stevens, a procedure which was called, “Full Robotic Assistance For Laparoscopic Tubal Anastomosis.” In 1996, the first live telecast of laparoscopic surgery performed remotely via the internet was achieved (Robotic Telesurgery).

Recently, Computerized designing of laparoscopic instrument is introduced and microprocessor controlled safety features are added. Now it is impossible to stop the speed of growth of minimal access surgery and every day new procedures are  added on its list.

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