Five thousand years of minimal access surgery: 3000BC to 1850: early instruments for viewing body cavities

Abstract

Surgeons and their patients recognise that one of the major advances in surgical technique over the last 20 years has been the growth of minimal access surgery by means of laparoscopic and robotic approaches. Partnerships with industry have facilitated the development of advanced technical instruments, light sources, recording devices and optics which are almost out of date by the time they are introduced to surgical practice. However, lest we think that technological innovation is entirely a modern concept, we should remember that our predecessors were masters of their craft and able to apply new technologies to surgical practice. The history of minimal access surgery can be traced back to approximately 5000 years ago and this review aims to remind us of the achievements of historical doctors and engineers, as well as bring more modern developments to wider attention.This review will comprise a three-part series:Part I 3000BC to 1850 Early instruments for viewing body cavitiesPart II 1850 to 1990 Technological developmentsPart III 1990 to present Organisational issues and the rise of the robots.

Keywords: Surgery; general surgery; history of medicine.

Figure 1.

Hammurabi Code of the Law. Inscribed on large black pillars, this ancient text contains one of the earliest law codes in the then-civilised world, along with documentation of art, history, science and literature.

Figure 2.

‘Endoscopes’ taken from Susruta Smhita – Section I, chapters VII and VIII (diagram taken in part from Natarajan, 2008).

Figure 3.

Hippocrates.

Figure 4.

Ruins of Pompeii.

Figure 5.

Bozzini’s Der Lichtleiter (1806).