Past, Present, and Future of Minimally Invasive Abdominal Surgery.

Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques.

Endoscopy and laparoscopy: a historical aspect of medical terminology.

INTRODUCTION: The history of medical terminology is interrelated with the scientific advances in the field. Efforts to explore human cavities for diagnostic and therapeutic purposes began as early as the 5th century BC. The evolution of laparoscopy at the beginning of the past century has been a major step toward minimization of surgical trauma. The present article investigates the terminological origin and the evolution of the terms endoscopy and laparoscopy. METHODS: A search of ancient bibliographical archives and a review of the modern medical literature was undertaken. RESULTS: The word endoscopy derives from the Greek word endoscópesis, a compound word consisting of éndon, which means inside and scopeín, which means to watch carefully. Laparoscopy also is a compound word, consisting of the words lapára, which means abdomen or abdominal wall, and scopeín. The word lapára derives from the adjective laparós, which means soft. The word lapára may be traced back to the Linear B syllabic script (17th to 13th century BC), as well as in descriptions of fights by the epic poet Homer (8th century BC). Although endoscopic examinations had been performed since the 5th century BC, the term endoscopy is first encountered in medical manuscripts of the 19th century AC, after the evolution of novel instruments and following the advent of artificial light. Similarly, the word laparothoracoscopy was first used in the early 20th century. CONCLUSIONS: The origins of the words laparoscopy and endoscopy are traced back to the archaic period and later to the classical years of ancient Greece. The everlasting semantic of these origins is revisited in the 21st century, as minimization of surgical trauma with the aid of modern technology substantiates the diachronic objective "to do no harm."

The rod and the serpent: history's ultimate healing symbol.

The snake has served as a medical emblem for more than 2400 years, since its association with the ancient Greek god of medicine and healing, Asclepius, in the 4th century BC. Its symbolic background can be traced further back to the worship of gods of earth's blossom in ancient Egypt and earth-related deities of the archaic period of Greek antiquity. It is featured entwined around a staff of knowledge and wisdom in most anaglyphs depicting Asclepius. The snake was impressed in the Old and the New Testament as well as in the Christian tradition as a symbol of sin, rejuvenation, death, resurrection, asthenia, and therapy. It is postulated that the double-snake motif was reintroduced by Renaissance philosophers as a medical emblem due to the symbolic connections of Hermes with deliverance and redemption. However, its use during the last two centuries seems to lack substantial historical background. The historical, mythological, and traditional retrospection of the snake's symbolism validates its appropriateness in the health-care field.

Reflections of the Hippocratic Oath in modern medicine.

Hippocratic Oath indicates a prevailing ethos rather than a professional approach, and it is still regarded as the cornerstone and foundation of the medical profession. Medicine in Ancient Greece was strongly influenced by the values of classical philosophy as introduced by its main representatives: Plato and Aristotle. Hippocrates himself has been recognized not only as a pioneering physician, but also as an outstanding philosopher. In his writings, he claimed that "the physician must insert wisdom in medicine" and denounced the technocratic aspect of the medical profession. The Hippocratic Oath constitutes a synopsis of the moral code of Ancient Greek medicine and contributes to the stabilization of the tri-part relationship among the physician, the patient, and the illness, as described by Hippocrates. The harmony of this interactive triangle has been deranged by several factors, such as technological evolution, public media, and cost-effective modalities with multiple consequences. In these terms, the reevaluation of the Hippocratic Oath and its time-enduring messages seems essential to reinstate the relationship between the physician and the patient under a new philosophico-medical prism.