Fuente: http://laparoscopy.blogs.com/endoscopyhistory/ TABLE OF CONTENTS PROLOGUE PART I) ENDOSCOPY AS A PHILOSOPHY: ANCIENT – EUROPEAN SCIENTIFIC REVOLUTION Chapter 1. Endoscopy as a Philosophy Chapter 2. Ancient to Pre-Modern Period Chapter 3. Renaissance, Scientific Revolution, Age of Enlightenment Chapter 4. Hovering on the Brink of Modernity Chapter 5. The Anatomy of a Pioneer PART II) 1800-1877: BOZZINI, DESORMEAUX, CRUISE Chapter 6. Bozzini: The Beginning of Early Modern Endoscopy Chapter 7. Post-Bozzini Chapter 8. Desormeaux Chapter 9. After Desormeaux Chapter 10. The Larynx Illuminated PART III) 1870s-1899: THE ERA OF NITZE Chapter 11. The Era of Nitze PART IV) EARLY 20TH CENTURY: 1900-1939 Chapter 12. Early 20th Century Chapter 13. The Glory Days of Endoscopy Chapter 14. Recap of Where Endoscopy Stood Chapter 15. Endo-Urology Chapter 16. The Glory Days Part II PART V) 1940s –1960s: POST-WWII Chapter 17. 1940s Chapter 18. 1950s Chapter 19. 1960s PART VI) 1970 – PRESENT: ADVANCED OPERATIVE VIDEOLAPAROSCOPY Chapter 20. 1970s Chapter 21. The Fight for Reproductive Rights Chapter 22. Nezhat & the Rise of Advanced Operative Video-Laparoscopy Chapter 23. 1980s Chapter 24. 1990s PROLOGUE Taking on the subject of the history of endoscopy can be a most confounding undertaking, for its development has been shaped by an often inscrutable entanglement of paradoxical forces, making the story one which nearly defies analysis. All manner of social, economic, and cultural influences have at one time or another been implicated in the endoscope’s development. Still other theories abound to explain the “vicious cycles” between acceptance and resistance that so plagued the endoscope’s history. Not simply a story of science then, the endoscope itself seems to have taken on meaning more closely achieving that of allegorical significance. Cast in such symbolic undertones, pinning down an accurate interpretation of the endoscope’s history is therefore a task fraught with complexity. From the outset then, I begin by acknowledging that this glimpse into the past is only one interpretation of the history of gynecologic endoscopy, one that may fall somewhat short of obtaining a perfected understanding. Of course too, no brief historical account could do justice to the countless individuals whose sometimes unrecognized efforts proved so crucial for endoscopy’s progress. Despite such constraints, we have attempted to cast our net of analysis as broadly as possible, taking care to illuminate in particular contested histories that have been hitherto greatly misunderstood or altogether unexplored. Special attention has also been given to analyzing changes in surgical traditions, most especially the rise of videolaparoscopy and the extent to which this departure from orthodoxy served to so radically redefine the entire field of surgery. We have striven as well to provide the most accurate research as possible, taking care to extensively cross-reference all sources, seeking out archival documentation whenever possible, and investigating more fully secondary sources so often overlooked. Through this vigorous research we have indeed come across multiple discrepancies within the historical records. In such cases, we offered for the reader multiple perspectives into these contested histories so that a more balanced understanding could be achieved. Despite these many difficulties complicating its history, exploring the endoscope’s development has nevertheless been an extremely important undertaking; for the real story behind endoscopy is, above all, one that truly reflects the glory of the human spirit. It symbolizes our shared humanistic experience of struggling between the exhaustive extremes of dreaming and doubting. Just as importantly too, the story of endoscopy serves as a source of continued inspiration for all of us within the medical community, for it demonstrates that dreaming for a better way can pay off and that individual efforts can and do make a difference in driving forward profound transformations within science and society. PART I) ENDOSCOPY AS A PHILOSOPHY: ANCIENT – EUROPEAN SCIENTIFIC REVOLUTION CHAPTER 1 Endoscopy as a Philosophy Perhaps the most unique aspect of the history of the endoscope lies in the issue of categorization. Just what is endoscopy anyway? Is it an instrument or technique? “Revolution or Evolution?” Many have come to understand the meaning of endoscopy as merely that of a technology or instrumentation. Because its roots as an almost exclusively diagnostic tool are so recent, this limited conceptualization has been somewhat difficult to escape. A more accurate definition however places endoscopy firmly in the realm of a new philosophy, one rooted in what is now referred to as minimally invasive surgery. Interestingly, the idea of minimal intervention is not necessarily a modern phenomenon. Historical artifacts provide plausible evidence indicating many ancient societies had an interest in minimal intervention as far back as 4,600 years ago. In fact, prior to the mid-19th century, surgeons very rarely operated on the abdominal cavity. Rather, their efforts were confined to indirect methods such as dietary changes and purgatives. One may also interpret much of the Hippocratic Corpus as predominantly advocating this minimalist approach, as can be inferred by the modern version of the Hippocratic ancient edict “First, do no harm.” Hippocrates specifically instructed physicians to avoid as much as possible invasive methods, allowing instead allow for the body’s own miraculous powers of healing to take effect. Of course, this approach was certainly influenced by the fact that invasive surgeries were almost unthinkable, as the mortality risk from infections was simply too great. Nevertheless, in reviewing the history of medicine, we can see that a philosophy of minimally invasive medicine has been an integral part of medicine for thousands of years. “Big Surgeon = Big Incision” Sometime between antiquity and the late 19th and early 20th century, the favored form of surgical intervention transformed into one dominated by big incisions. Exploratory laparotomies eventually came to be understood as integral to the treatment and diagnosis of many types of disease states that had defied other methods of diagnosis. Ironically, this growing preference for “classical” open surgery was most likely influenced significantly by the scientific advances in asepsis and anesthesia during the same time period, discoveries which finally ushered in the era of modern medicine. With the advent of anesthesia and antiseptic however, this meant that for the first time in living patients the physician could now get right to the source of disease without having to rely on deductive reasoning or blind biopsies. Diseases of the abdomen could now be palpated, visualized, and treated surgically. Paradoxically then, while treatment options and recovery rates expanded, so too did the circumference of incisions. Open approaches were soon codified as the gold standards of “classical surgery,” a point that later served to interfere substantially with endoscopy’s progress . The Modern Era of Planx’s Quantum Physics and Einstein’s Relativity The more we live by our intellect, the less we understand the meaning of life. –Leo Tolstoy Taken collectively, these great strides in medicine, coupled with parallel advances in science and technology so characteristic of this late Industrial era, engendered a growing sense of scientific infallibility. By the 20th century, great thinkers such as Einstein, Hans Otto and Max Planx were revolutionizing classical understandings of science. Even Newtonian physics was called into question during this transformative time. In fact, after a nearly 200 year reign as supposedly irrefutable fact, many of Newton’s empirical observations of gravity were found to be significantly flawed, as demonstrated by Einstein’s brilliant theoretical work [1]. Traditional surgical conventions continued to undergo rapid change as well. The surgeon, once referred to as a mere butcher in Hippocrates’ time, was, by the 19th century, transformed into an idealized father-physician, whose unique position of authority over the human body was accepted in some sense as a reassuring presence amidst the uncertainties of life and death. Such changes in the surgeon’s status were reflected in the growth of new elite societies for surgeons only. Surgeons thusly began taking a place of prominence above internists and other disciplines. Many snappy aphorisms from our not too distant past supported this growing reverence for surgeons and by extension, for their surgical procedures too. Such sayings as “to cut is to cure, “the greater the surgeon, the bigger the incision,” and “wounds heal from side to side, not top to bottom,” were all common refrains which helped reinforce the prevailing attitude about the superiority of open surgical methods. Influenced by this entrenched dogma, the inherent morbidity associated with large incisions was de-emphasized, due mainly to the lack of surgical alternatives. Contrary to today’s standards, a large incision was seen as a necessary evil, unequivocally required to save the very life of the patient. In relation to certain death, the various morbidities and uncertainties associated with laparotomy were understandably viewed as acceptable risks given the medical limitations of the time. Yet, just like Newtonian physics, these classical theories of surgery would ultimately be challenged by the conceptual breakthroughs driven