Developmental stages of laparoscopic surgery

Laparoscopic Surgery

Today, the practice of laparascopic surgery, for the urologist concerns above all the partial or total ablation of the kidneys specifically for the treatment of cancer of the kidneys, correcting congenital anomalies of the ureteropelvic junction or the problems associated with pelvic organ prolapse, also known as genital prolapse among women, prostate cancer surgery and equally treatment of cancer of the bladder.

Operation by laparoscopy

The coelioscopy – or laparoscopy – is achieved by short incisions of the abdominal wall allowing the introduction of surgical instruments especially made for this type of endoscopic surgery.

The operator, who sees the operating field on a TV screen with the help of a Tri-CCD camera, that magnifies the image allowing the surgeon to see details invisible to the naked eye.

This considerable enlargement of the operating field and the controllability of the optical gives the most precise surgical movements enabling the operator to work on an entirely different level.

The early stages of laparoscopy goes back two centuries to Bozzini and the development of an endoscope that used the light of a candle as a light source.

Celioscopy or laparoscopy

But it was only in the last century, in 1901, that Georges Kelling from Dresde used, for the first time, the term coelioscopy to examine the abdominal cavity after stuffing it with air. This opened the path to numerous innovations linked to technological development that lead to modern laparoscopy.

  • In 1911, Edouard Jacobeus outlines laparothoracoscopy. Bernheim introduces organoscopy.
  • In 1918, Goetze developed a needle to create the pneumoperitoneum without damaging the abdominal organs
  • In 1938, the Hungarian Veress proposes the needle bearing his name and in 1944, Raoul Palmer establishes the principles of the gynecological examination by laparoscopy. Kurt Semme invents the automatic insufflator in 1960.

The first association of laparoscopists was created in 1971 by American Ggynecologists.

The First Laparoscopic cholecystectomy

In 1982, the first endoscopic camera opened the pathway to modern laparoscopy. Five years later, Philippe Mouret in Lyon in 1987 achieved the first removal of the gallbladder (cholecystectomy) by laparoscopy, for american surgeons, « the second french revolution ».

This first laparoscopic cholecystectomy indeed opened the pathway to abdominal surgery and digestive laparoscopy with notably :

  • Surgery of the colon and stomach (treatment of hiatal hernia and gastroesophageal reflux);
  • Obesity surgery (bariatric surgery);
  • Cure of inguinal hernia and other abdominal wall defects;
  • Excision of the pathologic spleen.

Endocrine surgery including the removal of the adrenal glands , thoracic surgery, pediatric surgery, gynecological surgery and cardiovascular surgery are also major areas of application.

The development of these techniques was made possible by the advances and ingenuity of the industry that could design and build instruments and the operating room environment suited to this technologically demanding surgery.

Urologic surgery

In urology, the first interventions date back to the 80’s, but the interventions are limited to rare indications such as treatment of varicoceles, the treatment of testicular ectopy and lymphadenectomy. In fact, the development of urologic laparoscopy started after the first kidney removal, performed by Claymann and Kavoussi in 1991, followed a few months later, by the same case of total nephrectomy performed in Dijon by a French team (Ferry).

Since 1994 considerable progress has been made with the acquisition of surgical experience: techniques have become standardized and reproducible.

Capturing the operating images enables the production of good quality video transmissions, as found in conferences or online, which are an important element of teaching surgeons coming more and more to these techniques.

In 1991, Schuessler in the USA carries out the first radical prostatectomy by laparoscopy, but is discouraged by the difficulty of the technique and abandons this path.

This achievement was honoured by Gaston in Bordeaux in 1997, quickly followed by Guillonneau and Abbou.

The feasibility and reproducibility of the technique was demonstrated and thus the prelude to its wide international distribution.

In 2003, Mani Menon in Chicago, performed the first robot-assisted laparoscopic prostatectomy (RALP). Since then, prostatectomy performed with the robot “Da Vinci Intuitive Surgical” has increased dramatically in power and now the majority of prostatectomies performed in the U.S. use this method.