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INTRODUCTION: Minimally invasive surgery is on the rise and is becoming more common. Its advantage over traditional open surgery is a quicker recovery time and minimized risk of infection along with an aesthetically more pleasing smaller scar. Although many different scopes and instruments perform minimally invasive techniques, all minimally invasive instruments evolved from endoscopy. It wasn’t until the 20th century that they began to diverge to separate studies. Therefore endoscopy is considered in regards to instrument evolution. History is full of twists and turns as different pieces of the scope progressed so its advancement has been separated into the principle obstacles, visibility and accessibility. These in turn are analyzed more deeply in discussion of lens technology, illumination, and the camera, along with trocars, insufflation, and flexible tubing.
RATIONALE: The intent of this research is to provide a broad history of the evolution of modern endoscopic instruments. It is important to understand the history of these instruments to appreciate the advancements of modern technology and understand the basics of how they perform internally. An understanding of the medical, mechanical, and surgical advances of this technology will help the student comprehend the complexities that are common to modern instrument development.
REVIEW OF THE LITERATURE: One of the principle sources included in this study was Nezhat’s History of Endoscopy from the Society of Laparoendoscopic Surgeons website.Other websites like General Surgery News and Corning helped provide information on more modern advancements. Many textbooks, encyclopedias, and atlases were found out in Western Michigan University’s Waldo Library and the private library at Bronson Hospital. Numerous other articles were obtained through interlibrary loan at WMU, among these are articles coming from Millikin University ILL, University of Missouri-Kansas City, and Wayne State University. Furthermore, personal recollections of endoscopy’s advancements were collected from Dr. Richard S. York and Simon Pang, principle engineer of R&D at Stryker Endoscopy.
ANALYSIS OF RESULTS: The concept of minimal invasion to diagnose and cure internal diseases has been around since 1700BC noted in the medical treaty Edwin Smith Papyrus and possibly as far back as circa 2640BC. Hippocrates is most often given credit for his minimally invasive approach to medicine and was one of the first to have written description of viewing the internal body with a speculum to diagnose hemorrhoids found in The Art of Medicine circa 400BC. From this concept modern endoscopy was to evolve in two main categories, visibility and accessibility. Visibility was achieved as each of the following components were discovered and improved throughout history. The advent of lens technology created the first mode of visualization in 1683 with scientist Antony van Leeuwenhoek. Later various methods of illumination increased visibility from natural sunlight, candlelight, to Edison’s light bulb, and finally the modern invention of fiber optics in 1970 by Drs. Maurer, Schultz, and Keck. The modern camera is the current mode of vision for surgeons. Accessibility was allowed as new entrances into the body were explored beginning with the humble orifice and advancing to incisions implementing the use of trocars as early as 25BC by surgeon Aulus Celsus, and later advanced to prevent insufflation gas leaks in 1920 by Ordnoff. Later, the introduction of insufflation, most importantly artificial insufflation developed by Kelling in the 1910s allowed for more room to access necessary organs. Furthermore, the advancement from rigid to flexible tubing provided the necessary movement to access nearly all parts of the body. All of these components and more went on to create the many branches of minimally invasive surgery that we know today such as laparoscopy.
CONCLUSION: Modern endoscopy should be viewed in awe as a modern marvel. It took man many years to advance simple technologies such as lenses and candlelight to cameras and fiber optics. The evolution of this technology is not only one with ancient and humble beginnings, but also one with a current special interest.
Ellison, Sarah, "The Historical Evolution of Endoscopy" (2015). Honors Theses. 2571.
Honors Thesis-Open Access