Laparoscopy in Abdominal Emergencies - Past and Future

In 1985, the laparoscopic removal of a gallbladder ushered in a new era in abdominal surgery. Laparoscopy thereafter was more quickly and widely accepted than had ever been the case with a new technique; it is now used routinely in surgery on every abdominal organ and in every possible indication. From very early times, physicians have wanted to look into the human body and view hollow organs through the body’s natural openings. Early on, a spoon-like speculum was used to look into the pharynx, anus or vagina, with mirrors reflecting candlelight or sunlight into the opening. In 1806, Bozzini’s endoscope introduced modern endoscopy, though the real breakthrough came about later in that century and was based on the catheter, one of the oldest medical instruments that had been used for more than 3000 years to allow drainage of the bladder. It was almost a century until Maximilian Nitze collaborated with Josef Leiter, an innovative Viennese instrument maker, to create an endoscope for practical use. Although Kelling performed the first esophago-gastroscopy in 1898, Schindler, using a semiflexible gastroscope designed by Wolf, came to be recognized as the father of gastroscopy. The German surgeon Kelling performed the first laparoscopy in 1905, just after the turn of the 20th century, though he called it a “coelioscopy.” Based on his experiments with pneumoperitoneum in animals, he intended to compress the stomach and duodenum to stop upper gastrointestinal bleeding. Important publications on early experience with laparoscopy included those by the Swedish internist Jacobeus (1910), Ruddock, an American (1937), and Kalk, a German (1951). The spring-loaded needle introduced by Veress in 1938 is still used today in slightly modified form to create a pneumoperitoneum.

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