Medical Research Archives. Volume 5, issue 6. June 2017. The evolution of gynecologic endoscopic surgery over 50 years – a pleasant adventure The evolution of gynecologic endoscopic surgery over 50 years – a pleasant adventure Author Liselotte Mettler Department of Obstetrics Abstract: and Gynaecology, Endoscopic surgery spans the wings from 1901 (Georg Kelling) till the cutting edge years with Raoul Palmer, Kurt University Hospitals Semm , Hans Frangenheim , Hans Lindemann and Jordan Schleswig-Holstein, Philipps in 1985 in gynecology , It did experience further multispecialitxy progress from 1985 – 2017 with higher Arnold-Heller-Str. 3, dexterity, precision , loss of anxiety, micro and robotic House 24, 24105 Kiel, surgery, single , multiple ports and robotic technology. The evolution has just begun and will lead to a bright future. The Campus Kiel, Germany, influence of industry, which has kept pace and actively Email: supported this development for years, is the driving force besides the heroes of doctors and engineers that bring up new [email protected] ideas. Without suitable technology, this dissemination would 1 Copyright 2017 KEI Journals. All Rights Reserved. Medical Research Archives. Volume 5, issue 6. June 2017. The evolution of gynecologic endoscopic surgery over 50 years – a pleasant adventure not have been possible. Endoscopic development and its future does depend on new inventions, on the audacity of leading heroes, their input into this field but also on their management of life to continue to survive and on a healthy and successful cooperation with the medical technical industry and the governments of our countries which grant us the freedom of research and development for the best of all our patients. In 1967 I attended a Medical meeting in Munich, Germany, and heard a lecture of Kurt Semm on Laparoscopic Surgery, it fascinated me. Kurt Semm became the chairman of the Kiel University Department of Obstetrics and Gynecology in 1970. This was were I graduated from medical school. At that time working in the jungles of Peru in General Surgery at the Amazone Hospital Albert Schweitzer I applied for a residency position in Gynecology and Obstetrics at Kiel university. He wrote me back that I can start any time, mentioning that a “jungle girl” should know what she wants and he did not need to see any application papers. That makes up my 50 years with Endoscopic Surgery (1967-2017) 2 Copyright 2017 KEI Journals. All Rights Reserved. Medical Research Archives. Volume 5, issue 6. June 2017. The evolution of gynecologic endoscopic surgery over 50 years – a pleasant adventure 1. History In 1911 internist Hans Christian Jacobaeus (1879-1937) from Stockholm introduced the Historically on the twenty-third of September term, ‘laparothoracoscopy’ [5]. He was first to 1901, Georg Kelling gave the historic lecture view thorax and abdominal cavity by on ‘Tour of the oesophagus and stomach by endoscopy and recommended endoscopic flexible instruments’ to natural history technique to view other body cavities. In scientists and doctors’ seventy-third meeting contrast to Kelling, he inserted the trocar in Hamburg. He also introduced his new directly without creating pneumoperitoneum. procedure that he called ‘Coelioscopy’ [1]. Jacobaeus began like Kelling by breaking Kelling had used his oral air insufflation down the adhesions under thoracoscopic apparatus for the intra-abdominal insufflation vision. together with a Nitze-cystoscope for Heinz Kalk (1895-1973), a gastroenterologist illumination to see the abdomen of a dog, in from Berlin, known as the founder of German animal experiment for the time. school for laparoscopy, developed a 135 o lens system and double trocar [6]. He used laparoscopy as a diagnostic method in “I question myself, how the organs will react diseases of liver and gallbladder. In the to the air introduced inside? To find out, I publication of his experiences in 1939, he have developed a method to introduce the reported over 2000 liver punctures under local endoscope in the closed abdominal cavity anesthesia with no fatalities. He broke down (Coelioscopy) (Kelling 1901). adhesions by laparoscopy. After an interval of a century and considering The insufflation of abdominal cavity by the status of endoscopy today, one can instruments was problematic for a long time. evaluate Kelling’s endoscopic work of as Kelling carried it out with the Fiedler trocar, follows: which had a blunt “mandrin” to avoid injuries; Contradicting the spirit of times, Kelling Otto Goetze (1886-1957) who coined the term had favored the endoscopic procedure to “pneumoperitoneum”, in 1918 produced a exploratory laparotomy [2] similar instrument with spring mechanism for air insufflation for contrast radiograms [7]. With far sight Kelling challenged the stage wise treatment of malignancy and In the year 1938, the Hungarian, Janos Veress for this purpose sent repeated reminders (1903-1979) developed a special cannula with for the primary use of endoscopic spring mechanism –with the aim to create procedure [3]. pneumothorax and consequently to treat tuberculosis which was prevalent at that time In 1901, Kelling advised –clearly [8]. With little modifications the Veress foreseeing the problems in training young needle is used still today to create doctors, to practice endoscopic procedures pneumoperitoneum for laparoscopy. Its on cadavers. A hundred years ago, special mechanism prevents injury to the dummies were not available to the pioneer internal organs during needle insertion of endoscopy through the anterior abdominal wall. Kelling, a visionary, had predicted use of In the 19 sixties gynecologists first began endoscopic interventions particularly, small operative interventions. However, the laparoscopy as day care procedures (1901) French gynecologist Raoul Palmer had [4]. already carried out laparoscopy in the Trendelenburg position in 1944. In this 3 Copyright 2017 KEI Journals. All Rights Reserved. Medical Research Archives. Volume 5, issue 6. June 2017. The evolution of gynecologic endoscopic surgery over 50 years – a pleasant adventure position the intestines were displaced out of even defined indications for the diagnostic the pelvis and consequently could be better laparoscopy in extrauterine pregnancy, assessed during the operation. Additionally, chronic lower abdominal pain, sterility and he required continuous gas insufflation, which ovarian tumours. was controlled automatically. Palmer also His monographs, ‘Laparoscopy and carried out the first laparoscopic sterilization Culdoscopy in Gynecology’[10], in Paris. ‘Laparoscopy in gynecology, surgery and The piercing of the umbilicus for the paediatrics’ [11], ‘Diagnostic and operative laparoscope by Raoul Palmer in 1946 was a laparoscopy in gynecology- atlas with color groundbreaking procedure in gynecology. illustrations’ [12] as well as countless Like Kelling, he called the endoscopic publications and lectures contributed to diagnostic procedure ‘Coelioscopy’ and further spread of the method. As clinic developed several methods to insert director in Konstanz he organized a European endoscope. The abdominal access involved congress on endoscopy in Konstanz. On the many technical difficulties because of mainly occasion of his eightieth birthday Semm blind insertion technique through the anterior praised Frangenheim for his contribution with abdominal wall [9]. these words: ‘today the name, Frangenheim is In 1950 Hans Frangenheim (1920 – 2001) inseparably associated with the gynecologic (Fig. 1) began his training in gynecology in laparoscopic methods. His achievements for Wuppertal, Germany with Anselmino and in Germany and for the world are epoch making 1951 came in contact with laparoscopy for the and will go down in the annals of history’ first time. He was called to the medical clinic [13]. in Cologne where a lower abdominal tumor Kurt Karl Stephan Semm (1927-2003) (Fig. 2) was diagnosed during hepatoscopy and further is regarded in Germany as the real father of line of treatment had to be decided. Looking operative laparoscopy, which he started to back he wrote: evolutionize from 1970 – 1995 as chairman of ‘I sensed there, that a new aid had presented the department of Obstetrics & Gynecology at itself for the field of gynecology and so began the University Clinics Kiel, Germany. Already to look into literature. A remark made by Kalk working under Richard Fikentscher (1903 – in a textbook had impressed me the most, 1993) in Munich he developed a new which said, it is certain that gynecology would universal abdominal insufflation equipment [14, 15]. He developed a pressure controlled open a big field of indications for laparoscopy’. apparatus called “CO2 Pneumo” for insufflating CO2 gas during laparoscopy to From Wuppertal we visited the Paris lectural minimize operative risks of endoscopy [16]. Raoul Palmer. For the development of This machine was already used from 1964 laparoscopy he concentrated on regulating onwards at the second university clinic for uncontrolled gas insufflation, developing new women in Munich and created the instruments and photographic documentation pneumoperitoneum automatically [16]. The of endoscopic findings. He had difficult time cold light (extracorporeal light that shone with German endoscopy firms. Finally, with across a bundle of fibreglass) was modified anesthesia equipment from Draeger, simultaneously developed. Together, they he succeeded in reducing the gas pressure eliminated intestinal burns and gas embolus from