6 HISTORICAL MILESTONES IN GALL BLADDER SURGERY

6 HISTORICAL MILESTONES?IN?GALL BLADDER?SURGERY

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Gall Bladder removal surgery for gall stones , also called Chole-cyst-ectomy , is the commonest and effective operation performed in the biliary tract. This has been ?possible due to the contribution and research of innumerable physicians and ?surgeons worldwide over the last few centuries.

However among the?many prominent ?Surgeons ?that adorn the history of gall bladder surgery like Dr Petit , Dr Stough Bobbs and Dr?Theoder Kocher, it is Dr Carl Johann August Langenbuch who ?is credited to have pioneered the concept and development of the first gall bladder removal surgery. Interestingly the first person to undergo the surgery was discharged from hospital after 6 weeks This has come a long way to the current status where patients undergoing Robotic/ Laparoscopic surgery can be discharged the same day.

Here we trace the 6 interesting milestones in the history of Gall Bladder removal Surgery.

1.??????Year 1420 : The first documentation of Gallstones

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A Florentine pathologist, ?Antonio Benevieni, in the year 1420?gave the first account of Gall stones in a woman who died with abdominal pain. Over the next few centuries, there were multiple descriptions in literature about the classic pain of gallbladder stones. However treatment remained primitive and ineffective till the 18 th century.

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2.??????Year 1743 : The start of Gall Bladder Surgery (Chole-cyst-ostomy)

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In?the year 1743,Dr ?Jean-Louis Petit , suggested removal of gall stones and draining the gall bladder. He developed a procedure to adhere the gall bladder to the skin , and inserting a trocar to remove gall stones and creating a fistula . This resulted in pain and continuous discharge from a wound .

Later in 1867 , Dr John Stough Bobbs from Indianopolis , Indiana , while?operating on a patient with severe pain , accidentally found a sac containing several solid bullet like structures (Gall stones). He opened the sac , which incidentally was the gall bladder and removed the stones and stitched it back again. At that time gall bladder was thought to be an important organ for life?and therefore removal was not considered.

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3.??????Year 1882 : Open Gall Bladder Removal?Surgery (Open Chole-cyst-ectomy)

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The German Physician Dr Carl Johann August Langenbuch from Lazarus Hospital in Berlin observed that only removal of stones gave temporary relief and caused more problems to the patient?and he was determined to give a permanent cure.

After developing the procedure on cadavers, he first successfully removed the gall bladder of a 43-year-old man who was suffering from gall stone disease for 16 years on July 15, 1882. The patient was discharged from hospital after 6 weeks . His initial report appeared in an journal in 1882 but was widely ignored and criticized.

However subsequent studies showed that Chole- cyst-ectomy as done by Langenbuch had a much better result than the Chole-cyst-ostomy that was done previously. By the end of the century it became a widely accepted procedure for gallstone pain.

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4.??????Year 1985 : Laparoscopic gall bladder Surgery (Laparoscopic Chole-cyst-ectomy)

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For over a century Langenbuch ‘s Open Chole-cyst-ectomy remained the gold standard treatment for symptomatic gall stones.

In 1901, Dr George Kelling , a German surgeon described “celioscopy “(looking inside with scope) in dogs after inflating the abdomen with air and after 22 years published his experience to the German society in 1923 of more than 25 such cases.?

However it took many decades for the development of lens system / imaging techniques and transfer of light beam to give quality image , a insufflator system to control the pressure of gas pumped into the abdomen and different thermal coagulation/ cutting techniques to control bleeding. The technological advances revolutionized the concept of surgery and initiated a new era of Minimally Invasive or key hole surgery.

It was in 1985?that German surgeon , Dr Erich Mühe ?performed the first laparoscopic Chole-cyst-ectomy , that is ,?removed a patient’s gall bladder through keyhole surgery using laparoscopic instruments. He presented his technique to the German Surgical Society in 1986 but was met with strong resistance and criticism. However his work was recognized after multiple studies proved its effectivity in 1992 by the German Surgical Society Congress

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5.??????Year 1997 : Single Incision Laparoscopic Chole-cyst-ectomy

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With the widespread development and standardization of laparoscopic procedure as standard of care for Gall stone disease over two decades , the subsequent advancement emerged in the form of Single Incision Laparoscopic Surgery for improved cosmesis, lesser pain?and quicker return to work.

It was in 1997 that the we have ?first published report of a Single Skin Incision Laparoscopic Cholecystectomy was by Dr Navarra. The idea of Scarless Surgery gained wide popularity among patients as well as surgeons with multiple publications worldwide comparing it to the standard laparoscopic procedure.

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6.??????Year 1997 : Robotic cholecystectomy

Ironically, the first Robotic surgical system was developed in the early years of laparoscopic surgery in mid 1980 s.?However it did not gain wide acceptance until the da Vinci? telesurgical robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was FDA-approved in 2000.?Technological advantages included the 3D visual platform with better ergonomics and more versatile instrumentation.

The first Robotic Chole-cyst-ectomy was performed by Dr Belgian Jacques Himpens in 1997, thereby initiating the first human use of the da Vinci? surgical system.

However in spite of all the technological advances , Standard Laparoscopic Chole-cyst-ectomy is considered to be the Gold standard procedure for symptomatic gall stones till date.?

NOTE: The dashes inserted into the words above are solely for pronunciation assistance and understanding and do not appear in the correct spelling of the words.

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