Historical Milestones in Female Pelvic Surgery, Gynecology, and Female Urology

1 Historical Milestones in Female Pelvic Surgery, Gynecology, and Female Urology





ON THE SHOULDERS OF GIANTS


From the earliest days of recorded medical history, physicians struggled with the problems of pelvic organ prolapse (Fig. 1-1), urinary incontinence, and vesicovaginal fistula. An inadequate understanding of pelvic anatomy plagued practitioners before the nineteenth century. Ignorance of asepsis, the absence of anesthesia, faulty suture materials, inadequate instrumentation, and suboptimal exposure delayed any consistent success until the mid-nineteenth century.



The evolution of pelvic surgery from the Hippocratic age to the antiseptic period is a fascinating one, where original theories occasionally fell from favor only to be resurrected and popularized by subsequent generations. Equally intriguing is the development of a wide array of innovative instrumentation and materials that often paralleled many surgical advances. This chapter is an attempt to touch upon the milestones that occurred along the way and to pay homage to the pioneers who helped shape a specialty and upon whose shoulders we stand. The author’s selection of important milestones in our specialty up to 1961 is shown in Table 1-1. Note that this chapter emphasizes American contributions and milestones that influenced contemporary thought, patient care, and surgical practices. I am grateful for the works of Dr. Thomas Baskett, Dr. James V. Ricci, and, particularly, Dr. Harold Speert, whose extensive research on the subject made this chapter possible.


Table 1-1 Timeline of Milestones Related to Pelvic Surgery and Female Urology

































































































































































Second half of first century AD Soranus’s (De Morbis Mulierum) first good description of the human uterus.
1561 First accurate description of the human oviduct. Observationes Anatomicae by Gabriele Falloppio.
1672 First accurate account of the female reproductive organs and ovarian follicles (“Graafian Follicles”) De Mulierum Organis Generationi Inservientibus by Regnier de Graaf.
1677 Description of the vulvovaginal glands, “Bartholin Glands.” De Ovariis Mulierum by Caspar Bartholin.
1691 Description of the female inguinal canal. Adenographia by Anton Nuck.
1705 François Poupart describes the inguinal ligament and its function.
1727 Jacques Garengeot modifies a trivalve speculum to better differentiate “vaginal hernias” during pelvic examination.
1737 Description of the peritoneum and posterior cul-de-sac. A Description of the Peritoneum by James Douglas.
1759 Description of the embryonic mesonephros or “Wolffian Body and Duct.” Theoria Generationis by Caspar Fredrich Wolff.
1774 William Hunter completes his monumental work, Anatomy of the Gravid Uterus, which remains the finest work on uterine anatomy to date.
1801 Joseph Claude Récamier popularizes the use of a tubular vaginal speculum to treat ulcers and infections of the vagina and cervix.
1803 Pieter Camper describes the superficial layer of abdominal fascia.
1804 Astley Paston Cooper describes the ligamentous covering of the pubis and its condensation above the linea ileo-pectinea as it extends from the pubis outward.
1805 Philipp Bozzini introduces his lichtleiter (light conductor), the earliest endoscope.
1809 Ovariotomy is performed by Ephraim McDowell.
1813 Conrad Johann Martin Langenbeck carries out the first planned and successful vaginal hysterectomy.
1825 Marie Anne Victorie Boivin devises the bivalve vaginal speculum.
1836 Charles Pierre Denonvilliers describes the rectovesical fascia.
1838 John Peter Mettauer uses lead sutures to perform the first surgical correction of vesicovaginal fistula in the United States.
1849 Anders Adolf Retzius describes prevesical space.
1852 James Marion Sims describes his knee-chest positioning of patients for vesicovaginal fistula repair.
1860 Hugh Lenox Hodge details the use of his pessary to correct for uterine displacement.
1877 Léon Le Fort describes his method of partial colpocleisis as a simple and safe means for treatment of uterine prolapse.
1877 Max Nitze introduces an electrically illuminated cystoscope.
1878 T.W. Graves designs a speculum that combines features of both bivalve and Sims’s specula.
1879 Alfred Hegar introduces his metal cervical dilator to replace laminaria.
1890 Friedrich Trendelenburg describes his technique for positioning patients to facilitate a transvesical approach in the repair of vesicovaginal fistula.
1893 Howard Atwood Kelly devises the air cystoscope for inspection of the bladder and identification and catheterization of the ureters.
1895 Alwin Mackenrodt provides a comprehensive and accurate description of the pelvic connective tissue and correlation with pelvic prolapse.
1898 Ernst Wertheim performs radical hysterectomy for cervical cancer.
1899 Thomas James Watkins performs an “interposition” operation for treatment of uterine prolapse associated with cystocele. Thus, the uterus is brought forth through an anterior colpotomy incision and sutured under the anterior vaginal wall, with the cervix secured posteriorly. The markedly anteverted uterus essentially pivots on twisted broad ligaments, thus producing antagonistic forces, because any dropping of the bladder increases the anterior displacement of the uterus, and any prolapse of the uterus elevates the cystocele.
1900 David Todd Gilliam describes his method of uterine ventrosuspension, whereby he ligated the proximal round ligament and attached it to the anterior rectus sheath lateral to the rectus muscle.
1900 Hermann Johannes Pfannenstiel introduces a transverse incision for laparotomy.
1901 Alfred Ernest Maylard advocates the oblique transection of the rectus muscles to improve exposure.
1901 John Clarence Webster and John Baldy introduce their suspension technique for correction of uterine retroversion, whereby the proximal round ligament is brought under an opening made under the utero-ovarian ligament and, ultimately, secured at just above the uterosacral ligament.
1909 George Reeves White noted that certain cases of cystocele were due to lateral paravaginal defects and thus could be repaired by reconnecting the vagina to the “white line” of the pelvic fascia.
1910 Max Montgomery Madlener introduces a popular female sterilization technique using ligation of the tube alone.
1911 Max Brödel becomes head of the world’s first Department of Medical Illustration at Johns Hopkins University.
1912 Alexis Victor Moschcowitz describes the passage of silk sutures around the cul-de-sac of Douglas to prevent prolapse of the rectum.
1913 Howard Atwood Kelly describes the Kelly plication stitch, a horizontal mattress stitch placed at the urethrovesical junction to plicate the pubocervical fascia and “reunite the sphincter muscle.”
1914 Wilhelm Latzko describes a technique for vaginal closure of vesicovaginal fistula following hysterectomy.
1915 Arnold Sturmdorf introduces his tracheloplasty technique.
1917 W. Stoeckel is the first to successfully combine a fascial sling and sphincter plication for treatment of stress urinary incontinence.
1929 Ralph Hayward Pomeroy devises a method of female sterilization involving ligation and resection of the tube.
1940 Noble Sproat Heaney describes his technique for vaginal hysterectomy using a clamp, needle holder, and retractor of his own design. His method for closing the vaginal cuff that incorporates peritoneum, vessels, and ligaments is known as the “Heaney stitch.”
1941 Leonid Sergius Cherney suggests a modified low transverse abdominal incision, whereby the rectus muscle is cut at its very insertion into the pubis to provide better access to the space of Retzius.
1941 Raoul Palmer popularizes the use of the laparoscope in gynecology.
1942 Albert H. Aldridge reports on rectus fascia transplantation as a sling for relief of stress urinary incontinence.
1946 Richard W. TeLinde continues the Johns Hopkins legacy in gynecology with the introduction of his text, Operative Gynecology.
1948 Arnold Henry Kegel describes his progressive resistance exercise to promote functional restoration of the pelvic floor and perineal muscles.
1949 Victor Marshall, with Marchetti and Krantz, describe retropubic vesicourethral suspension for stress urinary incontinence.
1957 Milton L. McCall describes his posterior culdoplasty to prevent or treat enterocele formation at vaginal hysterectomy.
1961 John Christopher Burch introduces his method of urethrovaginal fixation for treatment of stress urinary incontinence.


GYNECOLOGY IN ANTIQUITY


Gynecology in antiquity finds its roots in the Ebers papyrus (1500 BC) that portrayed the uterus as a wandering animal— usually a tortoise, newt, or crocodile—capable of movement within its host. Hippocrates perpetuated this animalistic concept, stating that the uterus often went wild when deprived of male semen. He provided the earliest description of a pessary, using a pomegranate to reduce uterine prolapse and using catheters fashioned from tin and lead to irrigate and drain the uterus. The seven cells doctrine of the Common Era replaced the animalistic concept, depicting the uterine cavity as being divided into seven compartments whereby male embryos developed on the right, females on the left, and hermaphrodites in the center. Similar notions remained popular until the Middle Ages. Soranus of Ephesus (AD 98 to 138) is commonly considered the foremost gynecologic authority of antiquity. He described the uterus based on human dissection and performed a hysterectomy for uterine prolapse. His writings provided the foundation for gynecologic texts up to the seventeenth century. The ancients used instruments fashioned from tin, iron, steel, lead, copper, bronze, wood, and horn. Those made of iron and steel were likely quite popular, but very few survived the oxidation of more than two millennia. Gynecologic instruments from the first century BC were unearthed at Pompeii, including forceps, catheters, scalpels, as well as massive bivalve, trivalve, and quadrivalve vaginal specula.




THE RENAISSANCE


The Renaissance period was marked by the rebirth of individualism and the release from the ban of authority. The rise of universities, the printing press, and the subsequent emergence of self-education elevated medicine to the next level and provided for a clearer understanding of female anatomy. Leonardo da Vinci (1452–1519), founder of iconographic and physiologic anatomy, provided the basis for modern anatomic illustration. His illustrations of female pelvic anatomy provide the earliest accurate descriptions of the fetus in utero. Unfortunately, his sketches were seen by only a few of his contemporaries and were not published until the end of the nineteenth century.


The first authenticated report of vaginal hysterectomy was given by Giacomo Berengario Da Capri (1470–1550) in 1521. He described two cases: one performed by him in 1507 and the other by his father. Ambrose Paré (1510–1590), a renowned military surgeon of the period, was the first to introduce vascular ligatures for hemostasis in place of cautery. However, the use of ligatures was not popularized until Baron Joseph Lister (1827–1912), a British surgeon, introduced a longer lasting aseptic suture in the mid-nineteenth century.


Andreas Vesalius (1514–1564) commissioned Jan Stefan van Kalkar to produce the most famous anatomic illustrations of all time, revolutionizing the science of anatomy and the manner in which it was taught. He was among the first to successfully challenge the teachings of Galen (ancient Greek physician) and asserted that the physician must perform cadaver dissection firsthand to learn the art. Hence, Vesalius made human dissection a viable and respectable profession. His illustrations provided an accurate description of the entire female urogenital tract and its vasculature, depicting the left ovarian vein entering the left renal vein for the first time. Distinguished pupils of Vesalius include Gabriele Falloppio (1523–1562), who provided the earliest accurate description of the human oviduct and who described the clitoris as a vasomuscular structure. Another pupil was Matthaeus Columbus (1484–1559), who is credited with the earliest use of the term labia, which he considered essential in protecting the uterus from dust, cold, and air. Last, his student Bartolomeo Eustachio (1520–1574) furnished the earliest accurate delineation of the uterine cavity and cervical canal.


Among the more comprehensive accounts of sixteenth century gynecologic surgery is Caspar Stromayr’s Practica Copiosa, which contains beautifully executed watercolors depicting diseases of women. Included are illustrations of the examination of uterine prolapse and placement of a pessary comprised of sponge bound by twine, sealed with wax, and dipped in butter (Figs. 1-2 and 1-3). Despite the many advances regarding pelvic anatomy during the Renaissance, the approach to most gynecologic problems changed very little from that which was popular during the classical period.



Mar 10, 2016 | Posted by in Reconstructive surgery | Comments Off on Historical Milestones in Female Pelvic Surgery, Gynecology, and Female Urology

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