Lithotomy from Greek for "lithos" (stone) and "tomos" (cut), is a surgical method for removal of calculi, stones formed inside certain organs, such as the urinary tract (kidney stones), bladder (bladder stones), and gallbladder (gallstones), that cannot exit naturally through the urinary system or biliary tract. The procedure is usually performed by means of a surgical incision (therefore invasive). Lithotomy differs from lithotripsy, where 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. Because of these less invasive procedures, the use of lithotomy has decreased significantly in the modern era.

History

Ancient history

Human beings have known of bladder stones 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 in 1901, and it has been dated to 4900 BC. The earliest written records describing bladder stones are in papyrus dating from 1500 BC in Ancient Egypt.

Ammonius, who practiced lithotomy in Alexandria circa 200 BC, coined the term lithotomy, and acquired the sobriquet Lithotomus from the instrument he developed for fragmenting stones too large to pass through a small perineal incision. The 7th-century Byzantine Greek physician Paulus Aegineta's Medical Compendium in Seven Books contains a description of lithotomy that closely follows that of Celsus.

Albucasis in the tenth century AD describes a procedure different from previous ones, using an incision to the side of the midline,) 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 procedure frequently 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. French composer Marin Marais wrote "Tableau de l'opération de la taille" ("tableau of a Lithotomy"), a musical description of the operation, in 1725.

A less invasive technique was described by Ottoman surgeons Sabuncuoğlu Serafettin and Ahi Ahmed Celebi in the sixteenth century, involving accessing the bladder through the urethra, and then washing it with fluid. 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 dilators of the canal, forceps and tweezers, lithotomes (stone cutters) and cystotomes (bladder cutters), urethrotomes (for incisions of the urethra) and conductors (grooved probes used as guides for stone extraction). The patient is placed in a special position on a lithotomy operating table, called the lithotomy position (which retains this name to the present day, when the same position is used for other unrelated medical procedures).

Move to less invasive 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.

Notes

  • Lithotomy. Institute and Museum of the History of Science, Florence, Italy.