‘Crushing the stone’: a brief history of lithotripsy, the first minimally invasive surgery

Abstract

OBJECTIVE To trace the history of lithotripsy, marking the start of minimally invasive surgery. METHODS Primary and secondary sources describing the development of lithotripsy as a method to treat common bladder stones were reviewed. RESULTS Lithotripsy emerged in the early 19th century as an alternative to the morbid and frequently fatal perineal lithotomy practised for thousands of years to relieve sufferers of bladder stones. Lithotripsy developed in stages, first by learning how to pass a straight hollow sound, then drilling stones to break them up, later by crushing them, followed by means to evacuate the fragments, finally by integrating the lithotrite with the cystoscope, permitting surgery under direct vision. CONCLUSIONS Lithotripsy evolved as the first minimally invasive surgical procedure owing to the ingenuity and skill of our urological forebears.

The French Contribution to the Evolution of the Procedure and the Instrumentation for Lithotripsy

“…Abraham Ravich (1889-1984) invented a visual lithotrite with a scissor handle for crushing the stone, very similar to that in use today. 9 Science brought physicians to a point not to "cut" the patients for stone disease, as the Hippocratic Oath forbid but rather manage them with minimally invasive activities. 16 …”

“…He added a bridge to hold the drill and the outer tube rigid and even tools to turn the stone and to regrasp it. 9 Baron Charles-Louis Stanislas Heurteloup (1793-1864) was both a lithotrite inventor and an operator. Although in London, in 1829, he performed the country's first lithotripsy and published his book "Principles of lithotrity."…”

“…8 He could operate for up to 2 hours and at the same time remove all the stone, instead of repeated sessions. 9 Using Bigelow's lithotrite as a model, Hugh Hampton Young (1870-1945) invented a cystoscopic lithotrite, in which the stone could be viewed inaugurating lithotriptoscope. Abraham Ravich (1889-1984) invented a visual lithotrite with a scissor handle for crushing the stone, very similar to that in use today.…”

“…Pierre Franco (1502-1560) 6 created an instrument with 4 jaws (quadrupulus vesicae), to remove stones transurethrally. 7 Ambroise Par e (1510-1590) invented also a bullet forceps (tire de balles), 8 and Santorio Santorio (1561-1636) designed a lithotripter consisting of a hollow tube and a central rod ending in 3 prongs and a cup (no record that it was ever used), 9 whereas Alphonso Ferri (1515-1595), professor of Surgery at Naples and Rome, invented and used an instrument called after his name the "Alfonsinum." 10 This was a 3-pronged pincer (with internal toothing) for the extraction of bullets from fire-arm wounds.…”

The Development And Status Of Extracorporeal Shock Wave Lithotripsy

“…The monks took about a year to discharge all gravel. He is the first person who have destroyed calculi mechanically [3,4] …”