A History of Flexible Gastrointestinal Endoscopy.

Surgeons have been involved, since the beginning, in the development and evolution of endoscopy. They have been instrumental in developing new methods and have been actively involved in most of the therapeutic applications. The continued evolution of endoscopic technique is inevitable and will involve the integration of new technology with innovative thinking.

Visceral Vistas: Basil Hirschowitz and the Birth of Fiberoptic Endoscopy.

Fiberoptic endoscopy was developed at the University of Michigan in the 1950s by gastroenterology fellow Basil Hirschowitz and 2 physicists. Previous methods to visualize the gastrointestinal lumen used rigid instruments that relied on rudimentary optical systems. They were limited in reach and caused patients considerable discomfort. Fiberoptic technology dramatically changed endoscopic practice. The fiberoptic endoscope, or fiberscope, was a flexible instrument that allowed direct inspection of the gastrointestinal lumen. Although many practicing endoscopists initially resisted its adoption, the fiberscope ultimately held sway. Studying the period from the fiberscope's first introduction in the late 1950s to its more widespread acceptance in the late 1960s may help us understand how a new technology makes its way into routine clinical practice.

Development of procedures and techniques for the office.

This article presents the evolution of current office-based surgery of the larynx, focusing on the development of the tools and techniques for these ambulatory procedures, including laryngoscopy, bronchoscopy, esophagoscopy, and current office-based interventions. Additionally, a historical timeline is presented for the development of office-based laryngology within the context under which laryngology, as a subspecialty, has evolved over the past 200 years, with questions posed to the reader regarding what further developments may arise and how those will affect the practice.

Two centuries of cystoscopy: the development of imaging, instrumentation and synergistic technologies.

The cystoscope used today is the product of centuries of development. The desire to view the cavities of the body was first described several centuries ago. The earliest true prototype was Bozinni's 1805 urethral viewing tube, on which many others were based. These primitive instruments were challenging to use for the operator, uncomfortable for the patient, and dangerous for both. Patient positioning was based on the method of bladder distension and the goal of the operation, rather than comfort. Images visualized by early models were inverted and backwards, and required the operator to be skilled in correcting this image. Reflected candlelight was used for illumination, and objects appeared small and distant. With the advent of lenses, prisms and the incandescent light, cystoscopy advanced to Nitze's prototype, a forerunner of the current cystoscope. Once the image quality was improved, instrumentation through the cystoscope was introduced, broadening the scope of urology, from the management of venereal disease to a premier surgical speciality. Finally, the invention of fibre optics and digital imaging provided the cystoscope used by urologists worldwide, giving unparalleled image quality, allowing for educational opportunities and a quality of patient care unimaginable to the early pioneers. An understanding of this past brings not only an appreciation of the technology currently available, but also a glimpse into what the cystoscope has the potential to become. From this past, it is clear that today's cystoscope is merely a forerunner of that which the future will bring.

[Introduction of cold light to endoscopy]. / Die Einführung des Kaltlichts in die Endoskopie.

It is the aim of the paper to describe how, 40 years ago, optic glass fibers were developed, and what has been K. Storz's contribution to the new technology. In 1951 the term "Cold Light" was used the first time for illumination of a French type film- and photoendoscope. In 1957 the gastroenterologist B. Hirschowitz at Ann Arbor, U.S.A. succeeded making glass fibers of high light-guiding properties. In 1961 the Cystoscope Makers Inc (ACMI) at New York using these fibers brought the first flexible gastroscope on the market, still equipped with a conventional electric lamp. But in 1960, the year before, the physicist's of ACMI, J. H. Hett and L. Curtiss built the first cold light endoscope using glass fibers for both light and images conduction. In the following years ACMI equipped all of his endoscopes with this new type of illumination. Not before 1963 did K. Storz and the other German manufacturers produce their first cold light cystoscopes. Not possessing the know-how of glass fiber manufacturing, they had to get their fibers from abroad. K. Storz transmitted the term "cold light", which before had been the label of his French-type endoscopes, to the new glass fiber illumination. He constructed an excellent light source for fiber illumination without having light cables of his own fabrication. That is why his name is intimately connected with cold light illumination. But, nevertheless, the invention of the new glass fiber illumination must be credited to B. Hirschowitz and the physicists of ACMI in the U.S.A.

The Hopkins rod-lens system.

Surgeons have always been ready to adapt advances in technology into their practice. The discovery by Wilhelm Roentgen of X-rays in 1885 was applied within weeks of its publication to the diagnosis of fractures and the location of foreign bodies. The development of the electric light bulb by Edison enabled Max Nitze, Professor of Urology in Berlin, to develop the electrically illuminated cystoscope, which he patented in 1877. By 1911, Hugh Young used a cystoscope with a punch device to perform transurethral prostatectomy. Rapidly other electrically lit 'scopes' were introduced--the gastroscope, bronchoscope, thoracoscope and so on. All had two problems: they were rigid instruments and lacked really brilliant illumination.

How cold light was introduced to arthroscopy.

In 1954, in a landmark publication, H. H. Hopkins reported that images could be transmitted through glass fibers. This stimulated many investigations and, in 1957, B. Hirschowitz at the University of Michigan, succeeded in constructing a much-needed flexible gastroscope using optic glass fibers. Coating of the fibers by glass of lower refractive index was the next major step forward. Optical fibers were thus insulated and the accuracy of the transmitted image and the light transmission capacity of the fibers were enhanced. Working with American Cystoscope Makers Inc, L. Curtiss and H. Hett were the first to use glass fibers for illumination in an endoscope, producing a flexible ureteroscope in 1960. The light transmitted by the fibers was named "cold light" because it produced little heat, but the term had been used before for other types of illumination. The first arthroscope equipped with cold light was Watanabe's arthroscope No. 22 built by Tsunekichi Fukuyo in 1967. However, Watanabe was not satisfied with the new instrument and he still preferred the conventionally illuminated No. 21 arthroscope with the offset tungsten bulb at his tip. After R. W. Jackson reintroduced the technique to North America, most American pioneers used this conventionally illuminated arthroscope as well. But the early European arthroscopists had cold light instruments made by the German manufacturers R. Wolf and K. Storz since 1969. These rod-lens cold light instruments expanded in all markets during the following decade.