Origin and history of laparoscopic surgery

Laparoscopic surgery was an important development in the history of surgery. It has changed the field of surgery in general. This article looks at the history behind this interesting surgical technique.

The idea of ​​laparoscopic surgery was first mentioned more than a century ago. However, the introduction of the technique into the general surgical field has only recently developed. Early physicians such as Albukasim (936-1013 A.D.), Frankfurt-born physician Phillip Bozzini, were among the first to develop methods to examine the inside of the body through small holes instead of holes. open surgery. During the mid-1800s, several scientists attempted to make endoscope-like instruments. The first efficient bronchoscope was developed in 1853 by Desormeaux. This instrument is used to examine the urethra and bladder. In the late 1800s, physicians Kussmaul and Nitze refined early endoscopic models and began to use their new tools in medical practice. Laparoscopy or endoscopic examination of the peritoneal cavity was first attempted in 1901 by George Kelling, who called this examination method "Celioscopy". In the early 1930s, the first reports of endoscopic interventions for non-diagnostic purposes were published. Initial laparoscopic procedures include lysis of abdominal adhesions and diagnostic biopsies of abdominal organs under direct imaging. During the 1960s and 1970s, laparoscopy became an important part of gynecological practice. Despite these technological advances, it was not until 1986, after the development of video computer chips that allowed the magnification and projection of images onto a television screen, that laparoscopic surgery techniques were truly integrated. integrated into general surgery. The first laparoscopic cholecystectomy was performed on a patient in 1987 by French doctor Mouret.

Endoscopy is a method that allows us to look inside the human body that was used as early as the ancient Greeks and Romans. The instrument considered to be the prototype of the endoscope was discovered in the ruins of Pompeii. That's when Philip Bozzini, who attempted to make a direct observation of the human body through a tube he created called a Lichicateiter (a light guide) to examine the urinary tract, rectum, and pharynx. throat in 1805. By 1853, Antoine Jean Desormeaux had developed an instrument specifically designed to examine the urinary tract and bladder. He named it "endoscopy" and this was the first time the term was used in history.
After a series of tests, a German doctor named Adolph Kussmaul succeeded in observing the insides of a living human for the first time in 1868. This was tested on a sword swallower, who could swallowed 47 long metal tubes with a diameter of 13 mm. Ten years later, two doctors named Max Nitze and Josef Leiter invented the cystoscope, and in 1881, Johann von Mikulicz and his colleagues created the first rigid gastroscope for practical applications. Finally in 1932, Dr. Rudolph Schindler invented the flexible gastroscopy, a modified version of the earlier ones. It allows inspection even when the tube is bent. This tube has a length of 75cm and a diameter of 11mm. About 1/3 of the entire length of the tube towards the tip can be bent to a certain extent. Rudolph Schindler examines the inside of the stomach through multiple lenses placed throughout the tube with a miniature light bulb.

The first attempts to develop a gastric camera were made by German manufacturers Lange and Meltzing in 1898, but they failed to develop a device for practical use.
In 1949, a doctor working at the University of Tokyo Medical Center asked the Olympus company to develop a camera that could take pictures and examine the inside of a patient's stomach. Olympus took on this difficult challenge and gastrocamera was born. The production of a stomach camera faced many difficulties such as producing the microscopic lens, detecting the strong light source, finding the most suitable material for flexible tube and film, as well as anti-corrosion measures. water leak. The researchers had to discover their own path and overcome obstacles through a lot of experimentation. In 1950, researchers also produced the first prototype. The device is equipped with a photographic lens located at the top of the flexible tube. Images were captured on monochrome film using a miniature, hand-activated, in-vitro bulb. This device is still too stub for full clinical use.
With the efforts of the development team at Olympus company and the doctors at the University of Tokyo Medical Center. They have developed a complete gastric imaging camera with the advantages of posing no risk to the patient, creating minimal discomfort, allowing imaging of any part of the stomach in a short period of time and Provides sharp images for easier diagnosis. The development and perfection of the gastrocamera was a rapid advance and the device was widely accepted by many physicians.

In the 1960s in the United States, a new material called glassfiber was developed that attracted a lot of attention in various industrial fields. The developers of the endoscope were among the first to switch to glass. For example, Basil Hirschowitz and colleagues used glass in an endoscope to take advantage of its property of transmitting light from one end to the other even when it is bent. Their endoscope allows a direct view of the inside of the stomach. After this time, for the first time, doctors can make a clear view of the inside of the stomach. However, the device failed to take pictures. This feature was made available in 1964 when the first gastroscope with a telescope, a much-anticipated camera, was invented.
Gastrocamera with a fiberoptic scope has eliminated the weaknesses associated with "eyeless" gastric cameras. At that time. It has been very well received, as an innovative product that opens up the future in diagnostics, as it allows direct visualization of gastric tissues for dynamic analysis. The efforts that followed were to find new methods, new technologies, and new materials. The era of stomach cameras came to an end around 1975, when they were completely replaced by fiberometers.
Furthermore, endoscopy finds wider applications for examining other body parts including esophagus, duodenum, large intestine, bronchi and gallbladder. In addition to clinical diagnostic applications, endoscopy is currently being used for therapeutic purposes, supported by progress made in endoscopic therapy. The endoscope has thus established itself as an indispensable tool in the medical community.

5.1. Microscope development The video camera is an endoscope with a built-in video camera using a CCD (charge coupled device). It converts the image into an electrical signal for display on a television screen. This new device allows doctors and nurses to check the internal condition of an organ at the same time as they view the screen so it is highly safe as it greatly improves the diagnostic accuracy. In addition, image processing can perform focus sharpness adjustment via electrical signal control to highlight lesions by enhancing specific color signals for easier viewing. New features like these broaden the horizons of endoscopic capabilities even further.
5.2 The emergence of ultrasound endoscopes Attempts to develop ultrasound endoscopes with transducers were launched at the same time as the development of the video camera. Endoscopic ultrasound aids in examining the surface of the digestive tract as well as the layers below it, thus allowing doctors to determine how much damage or ulcer has penetrated the stomach or intestinal wall and whether lymph node metastasis or not. As a result, endoscopes begin to take on a larger role as a clinical treatment tool rather than just a conventional diagnostic and examination tool.

November 2002 saw the launch of the world's first endoscope system based on High Fidelity Display (HDTV) technology, which completely changed the concept of endoscope. The system took full advantage of advanced imaging technology capable of providing clearer images for extremely accurate diagnoses so that a single lesion could not be missed in a minute.
The development of an HDTV system resulted in an exponential increase in the amount of information displayed on the screen, which increased the quality and type of picture to be viewed. With a larger number of scan lines and horizontal pixels than conventional systems, it allows for more realistic observation of minute details including extremely fine blood vessels and the surface structure of tissues. It features IHb color enhancement that highlights small tissue color variations and displays a simulated IHb distribution that facilitates detection of difficult-to-detect lesions. These features, combined with enlarging of moving and still images, as well as improvements made for easier insertion and more efficient testing and diagnostic capabilities have made the medical community watch as a new generation device. At the same time, the system is expected to make even more important contributions by reducing the time it takes for doctors to make a diagnosis while also reducing the patient's physical discomfort.
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References: olympus-global.com, ncbi.nlm.nih.gov