The document discusses the history and evolution of endoscopic and laparoscopic surgery from the 1800s to present day. Key developments include the first use of endoscopes in the 1800s, advancements in instrumentation and video technology in the 1900s enabling more complex procedures, and the explosion of laparoscopic surgeries starting in the late 1980s with procedures like laparoscopic cholecystectomy. The future of laparoscopy may include improvements like 3D imaging to enhance the surgical experience.

1. ENDOSCOPIC & LAPAROSCOPIC
SURGERY
Dr.Anil Haripriya
In the nearly 150 years since the urinary bladder was
first inspected telescopically, technical progress &
therapeutic alternatives have been limited until the last
two decades. Intervention using endoscopy included
only a slightly more extended view of existing spaces,
but alternatives in therapy were not a reality. With the
advent of Video-endoscope allowing co-operative &
assisted procedures, high energy light sources & high-
flow insufflation of distending gases, the stage was set
to provide alternative access for complex abdominal
surgical procedures. Thereafter followed an enthusiastic
explosion of “new” endoscopic procedures, the limit of
which was now only the imagination.
Perhaps the best legacy of minimal-access surgery not
to imply that an epitaph is being written - is an
alternative way of thinking. Surgery at the beginning of
century maintained that “more is better”. Whether in
radical mastectomies or regional colectomies, the more
resected the better the cure. We have seen the
upheaval of this paradigm in the later part of this

2. century, for which minimal access surgery can be
considered the logical extension. With the movement
toward “less is more”, the door is open to an
alternative school of surgery.
DEFINITIONS
ENDOSCOPY : examining the in-accessible body
cavities with the use of instruments through natural
orifices.
LAPAROSCOPY : viewing the internal organs, using
some form of a telescope, through ports made surgically
& not through the already existing body orifices.
“A revolution is evolution in leaps”
Evolution: can be classified as
I. Evolution of Laparoscopy.
II. Evolution of Instrumentation
(a) Endovision
(b) Insufflation
(c) Instruments
III Evolution of Operative (Therapeutic) Laparoscopy

3. I. EVOLUTION OF LAPAROSCOPY (in chronological
order):
1805: Philipp Bozzini, Germany , visualised the urethral
orifice with candle light & a simple tube called
“lichtleiter”. The “ lichtleiter” was presented to the
Faculty of Medicine in Vienna in 1805 for viewing
the human urethra. Unfortunately, the intended use
of the instrument was considered an unnatural act &
Bozzini was censured by this scientific body despite
no evidence that this device was ever used on
humans.
1843: Desormeaux coined the term “Endoscopy”. He
developed first urethroscope & Cystoscope using
mirrors to reflect light from a kerosene lamp. He
was awarded for the achievement.
1874: Stein, Germany developed photoendoscope.
1874: Nitze, Germany added lens system to the tube
allowing magnification of the area viewed. Nitze,
compelled by the concept of an internal light source,
stated “in order to light up a room, one must carry a
lamp into it”. He made a cystoscope with electrically
heated platinum wire light source placed behind a
quartz shield.
1880: Thomas Edison, USA invented incandescent bulb.
1883: Newman, Scotland, developed cystoscope using

4. a small incandescent light bulb at distal end.
1901: Ott, Russian gynaecologist introduced
“ventroscopy” for the inspection of abdominal
cavity. He described the use of head mirror to
reflect light into the speculum introduced through a
small abdominal wall incision.
1901: George Kelling from Dresdon introduced Nitze
cytoscope into a living dog & used room air for
insufflation. He called it “Kolioskopie”
1910: Hans Christian Jacobaeus of Stockholm coined
the term “thoraco-laparoscopy”
· First published report of 72 cases.
· Identified syphilis, tuberculosis, cirrhosis &
malignancy.
· Used trocar & cannula.
1911: Bertram M. Berheim, USA coined the term
“Organoscopy”.
· Used proctoscope with illumination by electric
headlight.
1920: Orndoff, Intern from Chicago, USA used the term
“Peritoneoscopies”.
· Designed pyramidal trocar point.

5. · Invented valve for trocars to prevent gas leakage.
1927: Heinz Kalk, a German hepatologist “Father of
modern Laparoscopy” devised system of lenses
for better visualisation. Introduced dual trocar. He
used laparoscopy as a diagnostic method for liver &
Gall Bladder disease.
1928: Bovie introduced technique for diathermy
1933: C. Fervers reported adhesionolysis and peritoneal
biopsies. While using “Cold Caurtery” - electro-
surgery & insufflating the abdomen with oxygen,
Fervers described an explosion inside the
peritoneal cavity with multiple audible “Detonations”
and “Flames” visible through the abdominal wall.
Thereafter, patient recovered but Fervers wisely
argued against the use of oxygen.
1937: John C. Ruddock, USA Intern-physician
· Reported 500 laparoscopies involving 39
biopsies.
· Published in Surgical Journal, even then,
general surgeons did not embrace laparoscopy.
Around this time enthusiasm was so great for this
new procedure that Short, an English surgeon,
advocated performing laparoscopy in the patients’
home adding interests to it domicilliary visit.

6. 1980: Patric Steptoe from England started to
perform Laparoscopic procedures in the operating
room under sterile conditions.
1982: First solid state camera was introduced.
1994: A robotic arm was designed to hold the
laparoscopic camera & instruments with the goal of
improving safety, reducing resource utilization &
improving efficiency & versatility of surgeon.
1996: First live broadcast of laparoscopic surgery
via the internet.
II. EVOLUTION OF ENDOVISION
Breakthrough Points:
1870s: Invention of Incandescent Light by Thomas
Elva Edison.
Development of Lens systems for scopes
1960s: Invention of Rod Lens System by Hopkins
and development of fiber optic cold light
transmission
1980s: Introduction of Computer Chip, Video
Camera in 1985 by Circon Corporation
(a) Endoscope

7. (b) Fiberoptic Cable
(c) Light Source
(a) Endoscope:
1879: Nitze developed the first scope using 3
lenses and air filled scope
Glass lenses relayed light more effectively than the
mirrors employed by Bozzini & Desormeaux. The
cystoscope remained same till further improvement
in Optics.
1950s: Fouresteir, Gladis, Valmiere of Optical
Institute developed “Quartz Rod” for Light
transportation and magnification.
HAROLD H. HOPKINS:
British physicist developed Rod Lens Systems and
fiberoptics. Hopkins re-designed the Internal
systems of the Nitze Air filled Endoscope,

8. producing a solid glass-rod scope with internal air
spaces as lens interface. He, thereby, reverted the
normal setup by using glass, instead of air, to
conduct the image and air instead of glass to focus
the image. The higher refractive index of glass and
large apertures produced an image that was 80
times brighter than that produced by the classic
Nitze scope. Hopkin’s inventions effectively took
care of the problems of very poor transmission and
very poor image & color quality.
KARL STORZ of Germany picked up the Hopkins
innovations and developed the modern scope.
1957: Hopkins, Herschowatz et al developed Fiberoptic
bundle.
1963: “Cold Light System” to eliminate the risk of
thermal injury to bowel and other abdominal organs
caused by incandescent lighting.
Light Sources developed

9. · Halogen
· Metal Halide
· Xenon
III. Circon corporation developed solid state camera
with a silicon chip which picked up the image from
the laparoscope and transmitted it electronically
through a cable to a video processor which then
projected the image on television screen. With this
visual “Opening” of the closed abdominal cavity to
the entire surgical teams, more complex
procedures could be undertaken with a aid of
guided assistance.
III. EVOLUTION OF INSUFFLATION:
Although Kelling and others reported creation of a
new pneumoperitoneum using a needle and filtered
air, many laparoscopists introduced their trocars and
laparoscopes (usually modified Cystoscopes)
directly into the peritoneal cavity to avoid injury from
the insufflation & the possible side effects associated
with a pneumoperitoneum.
Evolution of components of insufflation:
§ NEEDLE

10. § GAS
§ INSUFFLATOR
§ “OPEN LAPAROSCOPY”
§ GASLESS
1918: Otto Goetze of Germany was first to
introduce needle for pneumoperitoneum.
1930: Janus Veress of Hungary developed “spring
loaded” needle for creation of pneumothoracis in
the treatment of tuberculosis. It is now being the
most frequently used device for creating
pneumoperitoneum.
It remains almost unchanged to the present day.
1924: Zollikofer,Switzerland, used carbondioxide
for insufflation instead of standard filtered air.
1971: H.M.Hasson, gynaecologist introduced “open
laparoscopy” or “Hasson`s technique”. Although
the Veress’s needle was quite safe, still the injury
to intra-abdominal organs was a great concern.
Hasson introduced blunt trocar & the canula fitted
with cone shaped sleeve that was movable along
the shaft of the canula, to which stitches
takenthrough the fascia could be tied, thus
preventing leak of gases & slippage of canula.

11. III. INSUFFLATOR:
upto 1960: Primitive affair using hand held bulb or foot
bellows.
1960: Kurt Semm from Germany developed automatic
insufflator
developed modern dissectors & coagulation
instruments.
Achievements of Kurt Semm
1935 : Monopolar coagulation
1960-66: Automatic insufflator
1968 : Hook Scissors
1971 : Bipolar coagulation
1976 : Endo loop applicator
(Roeder loop)
1979 : Endoligation techniques
: tissue morcellator
1982 : Myoma enucleator
1985 : Pelvitrainer
III EVOLUTION OF OPERATIVE LAPAROSCOPY

12. 1937: E. T. Anderson Laparoscopic tubal ligation
1972: Hulka Chips for Ligation
1977: Dekok reported Laparoscopic assisted
appendicectomy
1983: Semm First incidental
laparoscopic appendicectomy
1987: Schzeiber presented 70 laparoscopic
appendicectomies
1987: PHILLIP MOURET, Lyons, France performed first
laparoscopic cholecystectomy in human.
Within a year LAPAROSCOPIC EXPLOSION
occurred and many surgeons reported
laparoscopic cholecystectomy:
Dubois (Paris)
Perissat (Bordeaux)
Alfred Cuschieri (Scotland)
Mckernan and Saye (Georgia)
Reddick and Olsen (Nashville)
Petelin and Phillips: Laparoscopic CBD exploration
1990: Jocobs et al First laparascopically assisted
colectomy.

13. EVOLUTION OF DIFFERENT PROCEDURES:
LAPAROSCOPIC HERNIA REPAIR:
1982: Ger used prototype stapler
1990: Shultz and Corbitt stuffed mesh plugs into the
defects
Arreguin developed pre-peritoneal mesh repair
(TAPP)
Fitzgibbons laid intra-peritoneal onlay mesh
Philip and Dulucq developed totally extra peritoneal
mesh repair
LAPAROSCOPIC VAGOTOMY
1990: Katkhouda – anterior seromyotomy
Bailey and Zucker, USA – anterior highly selective
vagotomy combined with posterior truncal
vagotomy
1991: Bernard Dallemagne, Belgium performed highly
selective (anterior and posterior) performed first
laparoscopic Nissen fundoplication.
LAPAROSCOPIC UROLOGY
1976: Cortesi- laparoscopy for bilateral abdominal testis
in 18 yr old

14. 1979: Wicken- performed laparoscopic ureterolithotomy
by retro peritoneal approach
1985: Eshghi- laparoscopic guided percutaneous trans
peritoneal removal of staghorn calculi from a pelvic
kidney
1991: Clayman- Laparoscopic nephrectomy.
LAPAROSCOPIC SURGERY IN INDIA
1990: Prof. Tchemton E. Udwadia, Mumbai presented
the first laparoscopic cholecystectomy in 10th world
congress of digestive surgery at New Delhi.
FUTURE OF LAPAROSCOPY
3-D laparoscopy:
The surgeon’s ability to operate in a 3 – dimensional
field may increase the speed of surgery and decrease
the difficulty of the surgeons’ learning curve. At present,
the 3-D pictures lack the clarity of high definition, 2-
Dimensional video.