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Once upon a time in Endoscopy:

Dr Shashwat Jani M.S. GYNEC . DIPLOMA IN ENDOSCOPY. Assist. Prof., Smt .N.H.L. Mun.Medical College, Sheth V.S. General Hospital. Ahmedabad . Mobile : +91 99099 44160. E-mail : drshashwatjani@gmail.com Once upon a time in Endoscopy

Naming Ceremony…:

The word ENDOSCOPY was inherited from GREEK meaning… ‘ To Examine Within ’. The term endoscopy was first used between 980 and 1037 AD by Aricenna .’ 2 drshashwatjani@gmail.com Naming Ceremony …

Barso pehle ki baat hai…:

The first description dates to Hippocrates in Greece, for use of a speculum to visualize the rectum (460–375 BC). Hippocrates also advised injecting a large quantity of air into the intestines through the anus in the case of intestinal obstruction. B arso pehle ki baat hai … 3 drshashwatjani@gmail.com

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A three bladed speculum was found in the ruins of Pompeii* *A roman town buried by a volcano eruption near modern Naples, Italy - 79 AD). 4 drshashwatjani@gmail.com

The Journey begins now…:

In 1585 , Aranzi was the first to use a light source for an endoscopic procedure, focusing sunlight through a flask of water and projecting the light into the nasal cavity. In 1806 , Philip Bozzini , built an instrument that could be introduced in the human body to visualize the internal organs. He called this instrument " LICHTLEITER ". Bozzini used an aluminium tube to visualize the genitourinary tract. The tube, illuminated by a wax candle, had fitted mirrors to reflect images. The Journey begins now … 5 drshashwatjani@gmail.com

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In the 1865 , the first serviceable endoscope was presented by Desormeaux , nearly 50 years after Bazzini . 6 drshashwatjani@gmail.com

First Hysteroscopy…:

In 1869, Panteleoni of Ireland manage to visualize the uterine cavity of a woman using a cystoscope. First Hysteroscopy … 7 drshashwatjani@gmail.com

BAAP of Modern Laparoscopy…:

In 1879 , Max Nirze used lens to magnify the area to be illuminated. This is the fore runner of the optical system of the modern endoscopy. Nirze is called “ The Father of Modern Endoscopy ”. In 1887 , he modified Edison`s light bulb and created the first electrical light bulb for use during urological procedures . BAAP of Modern Laparoscopy … 8 drshashwatjani@gmail.com

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In 1901 , George Kelling did the 1st Experimental Laparoscopy . He insufflated air into the abdomen of a dog and used pneumoperitoneum and a cyctoscope on dog. In 1910 , Jacobaeus of Sweden was the first to introduce the pneumoperitoneum and adoption of Trendelenburg position , trocar and cannula . 9 drshashwatjani@gmail.com

Direct trocar entry…:

In 1911 , H.C. Jacobaeus , again coined the term " laparothorakoskopie " after using the procedure on the thorax and abdomen.  He used to introduce the trocar inside the body cavity directly without employing a pneumoperitoneum . Direct trocar entry … 10 drshashwatjani@gmail.com

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In 1920, Zollikofer of Switzerland discovered the benefit of CO2 gas to use for insufflation , rather than filtered atmospheric air or nitrogen. In 1929 , Kalk , a German physician, introduced the forward oblique (135 degree) view lens systems. He advocated the use of a separate puncture site for pneumoperitoneum . 11 drshashwatjani@gmail.com

S.I.L.S. … ?!?!?!?  :

In 1934 , Ruddock need an air for peritoneum and employed local anaesthesia . He designed a Single puncture operating laparoscope and its accompanying instruments with which biopsies could be taken. S.I.L.S. … ?!?!?!?  12 drshashwatjani@gmail.com

First Lap. TL …:

In 1936, Boesch of Switzerland is credited for doing the first laparoscopic tubal sterilization. In 1938 , Janos Veress of Hungary developed a specially designed spring-loaded needle . Interestingly, Veress did not promote the use of his Veress needle for laparoscopy purposes. He used veress needle for the induction of pneumothorax . First Lap. TL … 13 drshashwatjani@gmail.com

Concept of uterine manipulator…:

In 1947 , Roaul Palmer published his first 250 cases in which he used the lithotomy Trendelenburg position and created a gaseous distention. He also described using the uterine cannula to elevate the uterus. Concept of uterine manipulator … 14 drshashwatjani@gmail.com

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Videoscopic surgery …:

In 1953 , The rigid rod lens system was discovered by Professor Hopkins . The credit of videoscopic surgery goes to this surgeon who has revolutionized the concept by making this instrument. First Video Camera used by Dr Cameron Nehzat . Videoscopic surgery … 16 drshashwatjani@gmail.com

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In 1965 , Kurt Semm introduced an automatic insufflation device capable of monitoring intra-abdominal pressures. This reduced the dangers associated with insufflation of the abdomen and allowed safer laparoscopy. 17 drshashwatjani@gmail.com

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In 1970 , after becoming the chairman of Ob/ Gyn at the University of Kiel , his co-workers demanded that he should undergo a brain scan because, they said , “ Only a person with brain damage would perform laparoscopic surgery ” In 1966, Kurt Semm German Engineer and Gynecologist , introduced thermocoagulation , loop knots, irrigation device and performed endoscopic appendectomy as part of a gynecologic procedure.

Gynecs at their best …:

In 1968, Fragenheim noticed ovulation through laparoscope. In 1970 , Gynaecologists had embraced laparoscopy and thoroughly incorporated the technique into their practice…!!! General surgeons, despite their exposure to laparoscopy remained confined to traditional open surgery …!!!    Gynecs at their best … 19 drshashwatjani@gmail.com

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In 1972 , H.Coutnay Clarke first time showed laparoscopic suturing technique for hemostasis . In 1978 , Hasson introduced an alternative method of trocar placement. He proposed a blunt mini- laparotomy which permits direct visualization of trocar entrance into the peritoneal cavity. 20 drshashwatjani@gmail.com

First Test Tube Arrival…!!!:

In 1978 , Laparoscopy reached the zenith of glory when refined techniques described by Steptoe and Edwards for ovum retrieval , eventually resulted in embryo transfer and birth of a normal living child, Louise Joy Brown. 21 drshashwatjani@gmail.com First Test Tube Arrival …!!!

1st TLH… !!! :

In 1988, Harry Reich performed laparoscopic lymphadenectomy for treatment of ovarian cancer. In 1989, Harry Reich described first laparoscopic hysterectomy using bipolar desiccation; later he demonstrated staples and finally sutures for laparoscopic hysterectomy . 1 st TLH … !!! 22 drshashwatjani@gmail.com

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Semm was spectacularly productive in the late 1980 s, introducing several new morcellators , which could morcelate fist-sized myomas …!!! 23 drshashwatjani@gmail.com

Robotic … !!!:

In 1994 , FDA approved Robotic surgical device called AESOP (Automatic Endoscopic System for Optimal Positioning. Computer motion, Inc.). The da Vinci Robotic Surgical System and Zeus Robotic Surgical System. Robotic … !!! 24 drshashwatjani@gmail.com

Crticism… !!! :

Many surgeons say… " Laparoscopy is the by product of medical engineering ". Laparoscopy was initially criticized due to the cost of instruments and possible complications due to these sharp long instruments and difficult hand eye co-ordination . Many senior surgeons started saying " Laparoscopy is conspiracy against common man".   Crticism … !!!  25 drshashwatjani@gmail.com

Crticism… !!! :

By 1975 a huge heated debate had been brewing about whether or not the removal of ectopic pregnancies was indicated for laparoscopy and also tubal ligation by laparoscopy. Apparently there were some unexpected complications rates with the earliest procedures. As a result, laparoscopy was the target of intense scrutiny in the 1980s. The 1980 s represent what are arguably the most controversial years in laparoscopy’s entire history. 26 drshashwatjani@gmail.com Crticism … !!! 

Unfortunately, at the same time in the early to late 1980’s, there was significant resistance in the United States against operative laparoscopy.:

SAY NO TO LAPAROSCOPY…!!!??? 27 drshashwatjani@gmail.com Unfortunately, at the same time in the early to late 1980 ’s, there was significant resistance in the United States against operative laparoscopy.

Lekin… Achchhe din to aane hi wale the… !!! :

Minimal access surgery has developed rapidly only after Grand success of laparoscopic cholecystectomy in 1987 . In 1989, The 2 nd International conference for endoscopic surgery, held in Atlanta, was described as a boat-rocking success and represented the moment in which, finally, General Surgeons became convinced of operative laparoscopy as the future of surgery…!!! Der aaye durust aaye …!!!  Lekin … Achchhe din to aane hi wale the … !!!  28 drshashwatjani@gmail.com

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It took 5 years before Dr. Camran Nezhat was able to present his laparoscopic treatment of extensive endometriosis in 1985 . This was at the combined Canadian and American Fertility Society in Toronto, Canada. His paper was finally published in 1986 in Fertility and Sterility. At that time he reported laparoscopic treatment of Stage IV Endometriosis… 29 drshashwatjani@gmail.com

Gynecs were the Pioneers…!!!:

Before the introduction of laparoscopic cholecystectomy , Gynecologists were performing most of the advanced laparoscopic procedures. For example , in 1985, '86 and '89 , Dr. Camran Nezhat and his colleagues reported laparoscopic treatment of Stage IV Endometriosis involving the bowel, bladder and ureters which he had been routinely performing for years. 30 drshashwatjani@gmail.com Gynecs were the Pioneers …!!!

Ek ke baad ek… !!!:

Nezhat and colleagues , in this country, and Cainis in Clearmont , France, first reported Radical hysterectomy in the late 1980s and early 1990s. M.A. Pelosi introduced novel laparoscopic techniques of Single port laparoscopy. GA Vilos advanced Hysteroscopic techniques. Jacques Donnez and Hasson performed one of the first laparoscopic Supracervical hysterectomies. 31 drshashwatjani@gmail.com Ek ke baad ek … !!!

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Dazzling technological advances took center stage during this era of 1990s … The First Laparoscopic Robotic procedures were performed by T. Falcone , J. Goldberg, A. Garcia-Ruiz, H. Margossian , L. Stevens, a procedure which was called, “ Full Robotic Assistance For Laparoscopic Tubal Anastomosis .” In 1996 , the first live telecast of laparoscopic surgery performed remotely via the internet was achieved ( Robotic Telesurgery ). 32 drshashwatjani@gmail.com

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Recently , Computerized designing of laparoscopic instrument is introduced and microprocessor controlled safety features are added. Now it is impossible to stop the speed of growth of minimal access surgery and every day new procedures are added on its list…!!!  Rok sako to rok lo …!!! 33 drshashwatjani@gmail.com

Manzil abhi dur hai…!!!:

Still , as laparoscopists, our advocacy work to perfect and promote minimally invasive surgery is not done . There are still too many patients who are enduring needless open procedures. For example, in 1997 66.8% of hysterectomies performed in the U.S. were still done via laparotomy. Statistics from 2004 estimate that more than 7 million laparotomies (in all disciplines of surgery vs. 2.5 million laparoscopies) are performed for benign conditions in the US each year, with abdominal hysterectomies accounting for 500,000 of those cases, and another 500,000 accounting for unspecified cases (excluding the 1 million Cesarians ).  34 drshashwatjani@gmail.com Manzil abhi dur hai …!!!

Safety First…:

Laparoscopy is a technologically dependent surgery and before starting surgery every surgeon should have reasonably good knowledge of these instruments. Please put a board in your Hospital : “ Your Safety Is Our First Priority. “ Safety First … 35 drshashwatjani@gmail.com

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36 drshashwatjani@gmail.com THANK YOU

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37 drshashwatjani@gmail.com

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