The concept of minimally invasive, endoscopic surgery using natural orifices (i.e., mouth, nose, etc.) is not new. There is evidence that medical reeds and catheters made from gold were used to conduct surgery from as early as 3,000 BC in ancient Egypt, Mesopotamia, Greece, and Rome to perform minimally invasive endoscopies. However, it wasn’t until 1901 that the first laparoscopy treatment was performed in a dog, and in 1910 when the procedure was performed diagnostically in a human by Hans Christian Jacobaeus.
Open abdomen surgery is invasive and physiologically traumatic for patients. The desire to develop laparoscopic treatments stemmed from a need to reduce infection risk, patient trauma and overall recovery time.
Between the start of the 1900s to 1970s there were several advancements in minimally invasive investigations and operations due to technological advancements in optics and tools. Gynaecologist, Raoul Palmer, advanced laparoscopic tools through the war and post war eras and in the 1960s, along with his protégé, Kurt Semm, brought laparoscopic treatments into the modern era as a routine method to perform general and gynaecological surgeries. Although there was significant resistance to laparoscopic techniques in the 1960s, Semm revolutionised the technique through his invention of ‘cold light’ laparoscopes, mitigating the risk of internal burns that could occur with the previously used electric light.
Laparoscopy revolutionised gynaecology in the 1970s because it was deemed to be a faster, safer and more discrete alternative for many gynaecological procedures, thus giving women more autonomy over their reproductive health. Laparoscopic surgeries reduced hospitalised recovery time, meaning more surgeries could be performed. This led to improved clinical understanding of reproductive health issues such as endometriosis and pelvic adhesions. Female sterilisation and IVF are two key examples whereby laparoscopic surgery has not only advanced reproductive healthcare, but also improved the control that menstruating women have over their bodies.
Throughout the 1970s, British gynaecologist, Patrick Steptoe, adopted Palmer and Semm’s laparoscopic procedure specifically for female sterilizations in a more liberal Britain. Steptoe’s laparoscopic procedures were out-patient procedures and healing times were reduced in comparison to laparotomic sterilisation. The success of laparoscopic sterilisation in the UK paved the way for the US to begin a movement to end restrictions of female sterilizations and between 1970 and 1975 uptake of female sterilisations increased from 185,000 to 670,000 procedures per year.
Laparoscopic techniques also facilitated the development of In Vitro Fertilization (IVF), giving otherwise struggling couples a technological option for conceiving. Patrick Steptoe and Sir Robert Edwards, a pioneer in reproductive health, utilised laparoscopic techniques to extract eggs from ovaries for IVF. In a world where an unequal portion of blame associated with being childless is placed on women, IVF is liberating. In addition, laparoscopically removed eggs can be cryogenically frozen and preserved until women are ready to undergo pregnancy, enabling greater control over their reproductive health and when they choose to prioritise having children.