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Lithotomy from Greek for "lithos" (stone) and "thomos" (cut), is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the bladder and kidneys (urinary calculus) and gallbladder (gallstones), that cannot exit naturally through the urethra, ureter or biliary duct. The procedure, which is usually done by means of a surgical incision (therefore invasive), differs from lithotripsy, whereas the stones are crushed either by a minimally invasive probe inserted through the exit canal, or by ultrasound waves (extracorporeal lithotripsy), which is a non-invasive procedure.
Lithotomy was a common procedure in the past. The ancient Greek Hippocratic Oath includes a warning for physicians against the "cutting" of persons "laboring under the stone"; an act that was better left to surgeons (who were distinct from physicians at that time in history).
It was advanced in the 18th century and used well until the beginning of the 20th century. 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 later invented a technique for lateral vesical stone lithotomy in 1727, whereupon he was said to perform the operation in about one minute time (an important feat before anesthesia).
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 surgical table, called the lithotomy position (which, curiously, retains this name until present 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.
See also
Reference
- Riches E. The history of lithotomy and lithotrity. Ann R Coll Surg Engl. 1968 Oct;43(4):185-99.
External link
- Lithotomy. Institute and Museum of the History of Science, Florence, Italy.
"Lithotomy"