The Invention of the Laparoscopy (1901)
Georg Kelling (1866-1945) studied medicine at the University of Leipzig and launched his scientific career with the doctoral thesis entitled "On Measuring Stomach Capacity." He conducted experiments on animals and cadavers in which he insufflated air into the stomach and established the exact quantity needed to fill it.
In 1901, Kelling focused his attention on bleeding into the abdominal cavity, that time fatal for most patients. To halt blood seepage into the abdomen, Kelling proposed a high-pressure pneumoperitoneum (insufflation of air into the abdominal cavity), a technique he called the "air-tamponade.”
The creation of pneumoperitoneum was not a new idea. The first scientist to conduct systematic experiments with insufflation on animals was Georg Recklinghausen of Berlin (around 1877). 30. The earliest clinical pneumoperitoneum was performed by Albert von Mosetig-Moorhof (1838-1907) of Vienna. In May 1882, he insufflated air into the abdominal cavity of a four-year-old boy suffering from tuberculosis of the peritoneum.
In 1901, Kelling used both his experiments and experiments of other European scientists to calculate that a pressure of about 50 mm Hg could alleviate bleeding into the abdomen. Kelling devoted himself to inventing a special apparatus and conducting numerous experiments on dogs and cadavers.
Kelling carried out numerous experiments on live dogs, insufflating air up to the pressure of 100 mm Hg. He carefully controlled the dogs' pulse and breathing and the pressure in the arteria femoralis and carotis. Still, two of twenty dogs died. The reason for their sudden death was not entirely apparent to Kelling.
"I asked myself, how would the organs react to the introduction of air? To find out, I devised a method of using an endoscope on an unopened abdominal cavity (coelioscopy)," Kelling noted in 1901. To visualize the effects of the high-pressure "air-tamponade" on the abdominal organs, Kelling introduced a Nitze cystoscope directly through the abdominal wall. The brief description of this technique, which is known today as laparoscopy, introduced Kelling's name into the history of medicine.
All pictures from Grzegorz S. Lityński, "Highlights in the History of Laparoscopy" (Frankfurt/Main, Bernert Verlag, 1996), 360 pages.
Georg KELLING, "Ein einfaches Verfahren zur Bestimmung der Magengroesse mittels Luft," Dtsch Med Wochenschr 18 (1892): 1160-1163 and 1191-1194.
Georg KELLING, "Physikalische Untersuchungen über die Druckverhaeltnisse in der Bauchhöhle sowie über die Verlagerung und die Vitalkapacitaet des Magens," Samml Klin Vortr N F 144 (1896): 487-528.
[Albert von] MOSETIG-MOORHOF, "Zur Therapie der Peritonealtuberculose," Wien Med Presse 34 (1893): 1-4;
[Albert von] MOSETIG-MOORHOF, "Peritonealtuberculose," Wien Med Presse 34 (1893): 1053-1057.
Georg KELLING, "Die Tamponade der Bauchhöhle mit Luft zur Stillung lebensgefährlicher Intestinalblutungen," Muench Med Wochenschr 48 (1901): 1480-1483 and 1535-1538.
Hans J. REUTER and Matthias A. REUTER, "Philipp Bozzini and Endoscopy in the 19th Century," (Stuttgart: Max Nitze Museum, 1988).
Grzegorz S. Lityński, "Śladami pionierów laparoskopii," in Waldemar Kostewicz "Chirurgia laparoskopowa. (Warszawa, PZWL, 2002), pages 19-32.
Grzegorz S. Lityński, "Highlights in the History of Laparoscopy" (Frankfurt/Main, Bernert Verlag, 1996), 360 pages.