Society of Laparoscopic & Robotic Surgeons | Chapter 18

Chapter 18


The great tragedy of science – the slaying of a beautiful hypothesis by an ugly fact.
-Thomas Huxley

Huxley’s quote is apropos because, in the first year of this new decade the “ugly fact” about endoscopy was that the light source was still almost no better than Kelling’s time. However, dramatic changes were just over the horizon.

Diagnostic Laparoscopy Definitely Established
Despite the paltry lighting situation in the starting year of 1950, Ruddock reported in 1951 that “peritoneoscopy (laparoscopy) is now a definitely established diagnostic procedure and has been widely accepted throughout the world as another endoscopic method of examining body cavities” and that “It is now accepted as a safe diagnostic procedure in lieu of exploratory laparotomy in selected cases for a definite purpose.” Notice the use of the qualifying phrase “in selected cases for a definite purpose,” an indication that there were still some limitations to its application.

Gynecological Laparoscopists 1940s-1960s
Some of the earliest to take advantages of these new technologies were gynecological laparoscopists! Other events affecting our field include the founding of ACOG in 1951, with Dr. Woodward Beacham of New Orleans as its first president. Palmer in Paris was still leading the way in the 1950s, as were many other French laparoscopists including Soulas, Dubois de Montreynaud, and Troyer. Cohen was already working on cutting edge technologies and had introduced one of the earliest motion picture and photographing unit.

The development of gynecologic laparoscopy was characterized by sharp fits and staggered starts throughout much of formative years. The 1950s was no exception to this great revolution that did not come gently into being.

Indeed, by the late 1950s, laparoscopy needed a new generation of pioneers to help push its progress to the next level. Germany and the world received just such a pioneer in Hans Frangenheim of Wuppertal, who ended up becoming the most crucial force for advancing laparoscopy and keeping it alive as it faced a phase of indifference during this 1950s time period. Many have stated that this era’s broad interest and acceptance of laparoscopy was due largely to Frangenheim’s influence.

A Contrarian from the Start
For a time culdoscopy had influenced even the German school of thought in the matter. During the earlier part of Frangenheim’s career, many of his colleagues were in favor of this approach. However, Frangenheim was just not convinced and was deeply dissatisfied with the method. Despite criticism from those around him, Frangenheim made the switch to an abdominal approach and never looked back.

Frangenheim was deeply influenced by the published works of both Kalk and Palmer, and sought out their friendship and mentorship throughout his life. Frangenheim met with Palmer in 1955, which began a lifelong friendship between the two.

Frangenheim’s first article on his laparoscopic experience was published in 1958, in which he reported on over 350 laparoscopic examinations. As a fertility specialist, Frangenheim used the laparoscope to perform some of the world’s most groundbreaking organ-preserving, operative laparoscopic procedures, which were designed to preserve fertility. With his unique innovations in technique for operative procedures especially, Frangenheim made it clear that laparotomies could in fact be avoided in many cases.

Aside from his extensive research and publications, Frangenheim was also especially influential in bringing about technological advances specific to laparoscopy. He constructed an improved CO2 insufflator, and later became one of the first to adapt quartz rod technologies and later fiber optics. And many today still recall the moment when they first saw Frangenheim’ motion pictures of live laparoscopies, among the few to be introduced in the 1950s.

The First Textbook on Gynecologic Laparoscopy
In 1958, within the same year as his first publication Frangenheim also published one of the first textbooks on gynecological laparoscopy. Semm referred to this work as one of the most influential of the times, especially in German-speaking regions.

Semm, Cohen, and many other pioneers regard Frangenheim’s work as the most important and influential of the times, in the same league as Palmer and Kalk. His contributions to operative laparoscopy were especially groundbreaking, as were his extensive publications and seminal textbook. Frangenheim’s influence came at the most important time in the laparoscope’s life, when doubt and distrust about the procedure was just reaching a crescendo. Through his exceptional surgical skill, technical innovations, publications, and advocacy, Frangenheim became the central catalyst in revitalizing worldwide interest during laparoscopy’s second awakening.

Motion Pictures 1950s:
The World’s First Live Birth in Motion Picture– Mori and Yamadori

The stunning 1950s endoscopic revolution, fueled by the introduction of fiber optics remains utterly incommunicable. How does one succinctly describe something that overturned every last drop of technology for the endoscope, bringing in its wake an entirely new order of things? To give just a small glimpse into this phenomenal era, imagine the sound of jaws dropping when the world’s first live birth was captured by the newly motion picture outfitted fiber optic endoscopes. This is just what Mori and Yamadori must have heard when they presented their endoscopic first to the world. Using a glass fiber hysteroscope, Mori and Yamadori were the first to capture on film the birth of a human being. The author’s brief description on their achievement went as follows:

“The original production of the glassfibre hysteroscope and a study on the intrauterine observation of the human fetus… and the beginning of delivery by means of hysteroscopy and it’s recording on the film.”

This involved placing a movie camera on the inner side of the uterus wall so that views of the fetus during late pregnancy could be captured.

Eventually there was a beautiful deluge of innovation. TV and film technologies were utilized in surgery with more frequency after World War II. In 1950, Japanese pioneers from Hayashida Hospital, Uji, Fukami and Suginara, developed one of the earliest endoscopic cameras, the gastrocamera, while in 1953 Cohen and Guterman introduced their Cameron cavicamera, which was capable of filming and photography. Later, some of the most sensational moments in endoscopy’s history came with the debuts of the world’s first television and color film broadcasts by French pioneers; Palmer’s 1955 color film debut of the first live laparoscopy; and in the same year the world’s first ever television broadcasts of live bronchoscopies, achieved separately by the French bronchoscopists, Soulas and Dubois de Montreynaud. Within a few years, Frangenheim of Germany would produce his famous 1958 color film of a gynecologic laparoscopic surgery, a feat which would reverberate throughout the world of gynecologic laparoscopists for years to come. By 1959, closed circuit televisions had been experimentally introduced to the repertoire of endoscopic tools, though again it must be emphasized that these early examples were exceptions rather than the rule.