Odtnhj

Lithotomy
A kidney stone, 8 millimetres (0.31 in) in diameter
ICD-9-CM	51.04 (gallbladder) 51.41 (common duct) 51.49, 51.96 (bile passage or hepatic duct) 55.01, 55.03 (kidney) 56.2 (ureter) 57.19 (urinary bladder)
MeSH	D008096
[edit on Wikidata]

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 kidneys (kidney stones), bladder (bladder stones), and gallbladder (gallstones), 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.

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 BC. The earliest written records describing bladder stones date to before the time of Hippocrates (ca. 460–370 BC). 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, as distinct from physicians. Operations to remove bladder stones via the perineum, like other surgery before the invention of anesthesia, were intensely painful for the patient.^[1]

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.^[2][3] 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, that is "sharp on two sides" (Spinks and Lewis say it is difficult to reconcile the drawing of the knife to the procedure).^[1] 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.^[1]

In the 16th century, Pierre Franco (1505–1578) was a pioneer in the suprapubic lithotomy method.^[4]Frère Jacques Beaulieu (also known as Frère Jacques Baulot^[5][6]) 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^[7] and many others, was recently explored without finding any evidence for a connection.^[8]

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.^[9]

In England, William Thornhill performed his first suprapubic operation on a boy privately on 3 February 1722 or 1723.^{[citation needed]} 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 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 the present day, when the same position is used 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.

Notable people who were stone formers

Portrait of Jan de Doot, by Carel van Savoyen, holding the bladder stone he removed from himself according to a 1652 account in the book Observationes Medicae by Nicolaes Tulp

Famous people who were kidney stone formers include Napoleon I, Napoleon III, Peter the Great, Louis XIV, 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.^[10]

See also

• Lithotomy position


• Lithotriptor

Notes

External links

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


• 
  Bladder Stones at eMedicine