Lithotomy
Encyclopedia
Lithotomy from Greek
for "lithos" (stone) and "tomos" (cut), is a surgical
method for removal of calculi
, stones formed inside certain hollow organs, such as the kidney
s (kidney stone
s), bladder
(bladder stones), and gallbladder
(gallstone
s), that cannot exit naturally through the urinary system
or biliary tract. The procedure, which is usually performed by means of a surgical incision (therefore invasive
), differs from lithotripsy
, wherein the stones are crushed either by a minimally invasive probe inserted through the exit canal, or by an acoustic pulse (extracorporeal shock wave lithotripsy), which is a non-invasive procedure.
. The earliest written records describing bladder stones date to before the time of Hippocrates
(ca. 460-370 BC). However, lithotomy was a fairly common procedure in the past, and there were specialized lithotomists. The ancient Greek Hippocratic Oath
includes the phrase: "I will not cut for stone, even for the patients in whom the disease is manifest; I will leave this operation to be performed by practitioners," a clear warning for physicians against the "cutting" of persons "laboring under the stone"; an act that was better left to surgeons (who were distinct from physicians at that time in history). Operations to remove bladder stones via the perineum
, like other surgery before the invention of anesthesia, were intensely painful for the patient.
Ammonius
, who practiced lithotomy in Alexandria
circa 200 BC, acquired the surname Lithotomus from the instrument he developed for fragmenting stones too large to pass through a small perineal incision. His lithotomy scalpel was straight with an upper blunt edge enabling the thumb to apply pressure on it, while the lower edge was sharp, which enabled the operator to make a semicircular incision.
Aulus Cornelius Celsus
(1st century), and the Hindu surgeon Susruta produced early descriptions of bladder stone treatment using perineal lithotomy. Paulus Aegineta 7th-century Byzantine Greek physician his Medical Compendium in Seven Books. This work contained a summary of medical knowledge and was unrivaled in its accuracy and completeness. Paulus' description of lithotomy closely follows that of Celsus.
Albucasis follows Paulus almost word for word but then describes a different sort of knife one that is "sharp on two sides" (Spinks and Lewis say its difficult to reconcile the drawing of the knife to the procedure) Albucasis also adds using forceps instead of the scoop and chisel of Ammonius to break up the stone. Albucasis also uses a "drill" for stones impacted in the urethra, a technique not recorded earlier.
In the 16th century, Pierre Franco (1505–1578) was a pioneer in the suprapubic lithotomy method. Frère Jacques Beaulieu
(also known as Frère Jacques Baulot) developed an operation that went in laterally to remove the bladder stones in the late 16th century. Beaulieu was a travelling lithotomist and a Dominican
Friar, with scant knowledge of anatomy. Beaulieu performed the frequently deadly procedure in France into the late 16th century. A possible connection between the French nursery rhyme Frère Jacques
and Frère Jacques Beaulieu, as claimed by Irvine Loudon and many others, was recently explored without finding any evidence for a connection. Some have suggested that Frère Jacques was instead written to mock the Jacobin
monks of France.
Lithotomy was successfully performed by some practitioners in the 17th century, for example Johann Andreas Eisenbarth
(1663–1727). Other important names in its historical development were Jean Zuléma Amussat
(1796–1856), Auguste Nélaton
(1807–1873), Henry Thompson
(1820–1904) and William Cheselden
(1688–1752). The latter invented a technique for lateral vesical stone lithotomy in 1727, whereupon he was said to perform the operation in about one minute (an important feat before anesthesia
). French composer Marin Marais
wrote "Tableau de l'opération de la taille" ("tableau of a Lithotomy") a musical description of the operation, in 1725.
In England, William Thornhill performed his first suprapubic operation on a boy privately on 3 Feb. 1722-3. The records of his work, published by his colleague, John Middleton, M.D., prove that his experience in the operation and his success were greater than any contemporary English surgeon could show.
Special surgical instruments
were designed for lithotomy, consisting of dilator
s of the canal, forceps
and tweezers, lithotomes (stone cutter) and cystotomes (bladder cutter), urethrotomes (for incisions of the urethra) and conductors, (grooved probes used as guides for stone extraction). The patient is placed in a special position in a lithotomy operating table
, called the lithotomy position
(which, curiously, retains this name until present for other unrelated medical procedures).
Transurethral lithotripsy
, which was much simpler and with lower morbidity, complication
and mortality
rates, was invented by French
surgeon
Jean Civiale
(1792–1867) and largely substituted for surgical lithotomy, unless the crushing of calculi was difficult or impossible.
, George IV
, Oliver Cromwell
, Lyndon B. Johnson
, Benjamin Franklin
, Michel de Montaigne
, Francis Bacon
, Isaac Newton
, Samuel Pepys
(who held annual feasts to celebrate his survival on the anniversary of his operation), William Harvey
, Herman Boerhaave
, and Antonio Scarpa
.
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
for "lithos" (stone) and "tomos" (cut), is a surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
method for removal of calculi
Calculus (medicine)
A calculus is a stone that forms in an organ or duct of the body. Formation of calculi is known as lithiasis...
, stones formed inside certain hollow organs, such as the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s (kidney stone
Kidney stone
A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...
s), bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
(bladder stones), and gallbladder
Gallbladder
In vertebrates the gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated....
(gallstone
Gallstone
A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of...
s), that cannot exit naturally through the urinary system
Urinary system
The urinary system is the organ system that produces, stores, and eliminates urine. In humans it includes two kidneys, two ureters, the bladder and the urethra.-Kidney:...
or biliary tract. The procedure, which is usually performed by means of a surgical incision (therefore invasive
Invasiveness of surgical procedures
There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures ....
), differs from lithotripsy
Lithotripsy
Lithotripsy refers to the physical destruction of gallstones or kidney stones. The term is derived from the Greek words meaning "breaking stones" .Forms include:* Extracorporeal shock wave lithotripsy...
, wherein the stones are crushed either by a minimally invasive probe inserted through the exit canal, or by an acoustic pulse (extracorporeal shock wave lithotripsy), which is a non-invasive procedure.
History
Human beings have known of bladder stones ("vesical calculi") for thousands of years, and have attempted to treat them for almost as long. The oldest bladder stone that has been found was discovered in Egypt around 1900, and it has been dated to 4900 BCCommon Era
Common Era ,abbreviated as CE, is an alternative designation for the calendar era originally introduced by Dionysius Exiguus in the 6th century, traditionally identified with Anno Domini .Dates before the year 1 CE are indicated by the usage of BCE, short for Before the Common Era Common Era...
. The earliest written records describing bladder stones date to before the time of Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
(ca. 460-370 BC). However, lithotomy was a fairly common procedure in the past, and there were specialized lithotomists. The ancient Greek Hippocratic Oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
includes the phrase: "I will not cut for stone, even for the patients in whom the disease is manifest; I will leave this operation to be performed by practitioners," a clear warning for physicians against the "cutting" of persons "laboring under the stone"; an act that was better left to surgeons (who were distinct from physicians at that time in history). Operations to remove bladder stones via the perineum
Perineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
, like other surgery before the invention of anesthesia, were intensely painful for the patient.
Ammonius
Ammonius Lithotomos
Ammonius Lithotomos ,, of Alexandria, Greek lithotomist. Reported by Celsus he invented the tools to break up "bladder stones"....
, who practiced lithotomy in Alexandria
Alexandria
Alexandria is the second-largest city of Egypt, with a population of 4.1 million, extending about along the coast of the Mediterranean Sea in the north central part of the country; it is also the largest city lying directly on the Mediterranean coast. It is Egypt's largest seaport, serving...
circa 200 BC, acquired the surname Lithotomus from the instrument he developed for fragmenting stones too large to pass through a small perineal incision. His lithotomy scalpel was straight with an upper blunt edge enabling the thumb to apply pressure on it, while the lower edge was sharp, which enabled the operator to make a semicircular incision.
Aulus Cornelius Celsus
Aulus Cornelius Celsus
Aulus Cornelius Celsus was a Roman encyclopedist, known for his extant medical work, De Medicina, which is believed to be the only surviving section of a much larger encyclopedia. The De Medicina is a primary source on diet, pharmacy, surgery and related fields, and it is one of the best sources...
(1st century), and the Hindu surgeon Susruta produced early descriptions of bladder stone treatment using perineal lithotomy. Paulus Aegineta 7th-century Byzantine Greek physician his Medical Compendium in Seven Books. This work contained a summary of medical knowledge and was unrivaled in its accuracy and completeness. Paulus' description of lithotomy closely follows that of Celsus.
Albucasis follows Paulus almost word for word but then describes a different sort of knife one that is "sharp on two sides" (Spinks and Lewis say its difficult to reconcile the drawing of the knife to the procedure) Albucasis also adds using forceps instead of the scoop and chisel of Ammonius to break up the stone. Albucasis also uses a "drill" for stones impacted in the urethra, a technique not recorded earlier.
In the 16th century, Pierre Franco (1505–1578) was a pioneer in the suprapubic lithotomy method. Frère Jacques Beaulieu
Frère Jacques Beaulieu
Frère Jacques Beaulieu , also known as Frère Jacques Baulot, was a travelling lithotomist with scant knowledge of anatomy and was also a Dominican friar. Beaulieu performed the frequently deadly procedure in France into the early 18th century....
(also known as Frère Jacques Baulot) developed an operation that went in laterally to remove the bladder stones in the late 16th century. Beaulieu was a travelling lithotomist and a Dominican
Dominican Order
The Order of Preachers , after the 15th century more commonly known as the Dominican Order or Dominicans, is a Catholic religious order founded by Saint Dominic and approved by Pope Honorius III on 22 December 1216 in France...
Friar, with scant knowledge of anatomy. Beaulieu performed the frequently deadly procedure in France into the late 16th century. A possible connection between the French nursery rhyme Frère Jacques
Frère Jacques
"Frère Jacques" , in English sometimes called "Brother John" or "Brother Peter", is a French nursery melody. The song is traditionally sung in a round. When the first singer reaches the end of the first line the next person starts at the beginning...
and Frère Jacques Beaulieu, as claimed by Irvine Loudon and many others, was recently explored without finding any evidence for a connection. Some have suggested that Frère Jacques was instead written to mock the Jacobin
Dominican Order
The Order of Preachers , after the 15th century more commonly known as the Dominican Order or Dominicans, is a Catholic religious order founded by Saint Dominic and approved by Pope Honorius III on 22 December 1216 in France...
monks of France.
Lithotomy was successfully performed by some practitioners in the 17th century, for example Johann Andreas Eisenbarth
Johann Andreas Eisenbarth
Johann Andreas Eisenbarth was a German surgeon who was a native of Oberviechtach, Bavaria. Eisenbarth was an oculist and barber-surgeon who specialized in treatment of cataracts, calculus surgery, and the treatment of bone fractures...
(1663–1727). Other important names in its historical development were Jean Zuléma Amussat
Jean Zuléma Amussat
Jean Zuléma Amussat was a French surgeon.Amussat was born in Saint-Maixent, Deux-Sèvres. He became a renowned physician whose primary contributions were in the field of genitourinary surgery. Most of his work was through a private practice he held in Paris...
(1796–1856), Auguste Nélaton
Auguste Nélaton
Auguste Nélaton was a French physician and surgeon. Born at Paris, he began studying medicine in 1828 and was graduated as an M.D. in 1836 with a thesis on the effects of tuberculosis on the bones. Three years later, he became a professor at the Hôpital St. Louis with a habilitation on breast tumors...
(1807–1873), Henry Thompson
Sir Henry Thompson, 1st Baronet
Sir Henry Thompson, 1st Baronet FRCS , British surgeon and polymath, was born at Framlingham, Suffolk.-Medical career:...
(1820–1904) and William Cheselden
William Cheselden
William Cheselden was an English surgeon and teacher of anatomy and surgery, who was influential in establishing surgery as a scientific medical profession.-Life:...
(1688–1752). The latter invented a technique for lateral vesical stone lithotomy in 1727, whereupon he was said to perform the operation in about one minute (an important feat before anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
). French composer Marin Marais
Marin Marais
Marin Marais was a French composer and viol player. He studied composition with Jean-Baptiste Lully, often conducting his operas, and with master of the bass viol Monsieur de Sainte-Colombe for 6 months. He was hired as a musician in 1676 to the royal court of Versailles...
wrote "Tableau de l'opération de la taille" ("tableau of a Lithotomy") a musical description of the operation, in 1725.
In England, William Thornhill performed his first suprapubic operation on a boy privately on 3 Feb. 1722-3. The records of his work, published by his colleague, John Middleton, M.D., prove that his experience in the operation and his success were greater than any contemporary English surgeon could show.
Special surgical instruments
Surgical instruments
A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools...
were designed for lithotomy, consisting of dilator
Dilator
Dilator is a medical term with a number of uses, including:*A surgical instrument or medical implement used to induce dilation, that is, to expand an opening or passage such as the cervix, urethra, esophagus, or vaginal introitus....
s of the canal, forceps
Forceps
Forceps or forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...
and tweezers, lithotomes (stone cutter) and cystotomes (bladder cutter), urethrotomes (for incisions of the urethra) and conductors, (grooved probes used as guides for stone extraction). The patient is placed in a special position in a lithotomy operating table
Operating table
An operating table, sometimes called operating room table, is the table on which the patient lies during a surgical operation. This surgical equipment is usually found inside the surgery room of a hospital. An improvised suitable operating table can be composed of two kitchen tables that are...
, called the lithotomy position
Lithotomy position
The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations...
(which, curiously, retains this name until present for other unrelated medical procedures).
Transurethral lithotripsy
Lithotripsy
Lithotripsy refers to the physical destruction of gallstones or kidney stones. The term is derived from the Greek words meaning "breaking stones" .Forms include:* Extracorporeal shock wave lithotripsy...
, which was much simpler and with lower morbidity, complication
Complication (medicine)
Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathological changes, become widespread throughout the body or affect other organ systems. A...
and mortality
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
rates, was invented by French
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
Jean Civiale
Jean Civiale
Jean Civiale was a French surgeon and urologist, who, in 1832, invented a surgical instrument and performed transurethral lithotripsy, the first known minimally invasive surgery, to crush stones inside the bladder without having to open the abdomen...
(1792–1867) and largely substituted for surgical lithotomy, unless the crushing of calculi was difficult or impossible.
Notable people who were stone formers
Famous people who were kidney stone formers include Napoleon I, Napoleon III, Peter the Great, Louis XIVLouis XIV of France
Louis XIV , known as Louis the Great or the Sun King , was a Bourbon monarch who ruled as King of France and Navarre. His reign, from 1643 to his death in 1715, began at the age of four and lasted seventy-two years, three months, and eighteen days...
, George IV
George IV of the United Kingdom
George IV was the King of the United Kingdom of Great Britain and Ireland and also of Hanover from the death of his father, George III, on 29 January 1820 until his own death ten years later...
, Oliver Cromwell
Oliver Cromwell
Oliver Cromwell was an English military and political leader who overthrew the English monarchy and temporarily turned England into a republican Commonwealth, and served as Lord Protector of England, Scotland, and Ireland....
, Lyndon B. Johnson
Lyndon B. Johnson
Lyndon Baines Johnson , often referred to as LBJ, was the 36th President of the United States after his service as the 37th Vice President of the United States...
, Benjamin Franklin
Benjamin Franklin
Dr. Benjamin Franklin was one of the Founding Fathers of the United States. A noted polymath, Franklin was a leading author, printer, political theorist, politician, postmaster, scientist, musician, inventor, satirist, civic activist, statesman, and diplomat...
, Michel de Montaigne
Michel de Montaigne
Lord Michel Eyquem de Montaigne , February 28, 1533 – September 13, 1592, was one of the most influential writers of the French Renaissance, known for popularising the essay as a literary genre and is popularly thought of as the father of Modern Skepticism...
, Francis Bacon
Francis Bacon
Francis Bacon, 1st Viscount St Albans, KC was an English philosopher, statesman, scientist, lawyer, jurist, author and pioneer of the scientific method. He served both as Attorney General and Lord Chancellor of England...
, Isaac Newton
Isaac Newton
Sir Isaac Newton PRS was an English physicist, mathematician, astronomer, natural philosopher, alchemist, and theologian, who has been "considered by many to be the greatest and most influential scientist who ever lived."...
, Samuel Pepys
Samuel Pepys
Samuel Pepys FRS, MP, JP, was an English naval administrator and Member of Parliament who is now most famous for the diary he kept for a decade while still a relatively young man...
(who held annual feasts to celebrate his survival on the anniversary of his operation), William Harvey
William Harvey
William Harvey was an English physician who was the first person to describe completely and in detail the systemic circulation and properties of blood being pumped to the body by the heart...
, Herman Boerhaave
Herman Boerhaave
Herman Boerhaave was a Dutch botanist, humanist and physician of European fame. He is regarded as the founder of clinical teaching and of the modern academic hospital. His main achievement was to demonstrate the relation of symptoms to lesions...
, and Antonio Scarpa
Antonio Scarpa
Antonio Scarpa was an Italian anatomist and professor.-Biography:Antonio was born to an impoverished family in the frazione of Lorenzaga, Motta di Livenza, Veneto. An uncle, who was a member of the priesthood, gave him instruction until the age of 15, when he passed the entrance exam for the...
.
External links
- Lithotomy. Institute and Museum of the History of Science, Florence, Italy.