25 years of laparoscopic surgery, personal reflections: problems in laparoscopy in the past and present

Laparoscopy was developed by Kalk of Germany in 1929 as a routine procedure in internal medicine for diagnosis of liver diseases. Air was insufflated to create the pneumoperitoneum, and an electric lamp was placed at the end of the laparoscope to provide illumination of the abdominal cavity. Entrance into the peritoneal cavity was in the upper abdomen two finger breadths under the ribs. The danger of damaging the bowel by burning, etc. was very low. Previously laparotomized patients were considered an absolute contraindication for Laparoscopy. In 1946 Palmer, France turned the laparoscope from the upper abdomen to look into the lower abdomen. He called this technique Coelioscopy. It was used as for a diagnostic procedure mainly for the sterility patient in Gynecology. For coelioscopy Palmer used the same instruments as were used for Laparoscopy. The danger of burning bowel increased enormously as the protector of the upper abdomen, the omentum, was missing in the lower abdomen.