lithotomy n : surgical removal of a stone (calculus)
Etymologyfrom Greek for "lithos" (stone) and "thomos" (cut)
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.
HistoryHuman beings have known of bladder stones ("vesical calculi") for thousands of years, and have attempted to treat them for almost as long. The oldest bladder stone that has been found was discovered in Egypt around 1900, and it has been dated to 4900 BC. The earliest written records describing bladder stones date to before the time of Hippocrates (ca. 460-370 BC). Hippocrates himself wrote that, “To cut through the bladder is lethal.”
However, lithotomy was a fairly common procedure in the past, and there were specialized lithotomists. The ancient Greek Hippocratic Oath includes the phrase: ”I will not cut for stone, even for the patients in whom the disease is manifest; I will leave this operation to be performed by practitioners,” a clear 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).
Operations to remove bladder stones via the perineum were performed by Hindus, Greeks, Romans, and Arabs. Ammonius Lithotomos (200 BC), Celsus (first century), and the Hindu surgeon Susruta produced early descriptions of bladder stone treatment using perineal lithotomy.
In 1000, Abu al-Qasim al-Zahrawi (Abulcasis), in his Al-Tasrif, described a more successful extraction of bladder and kidney stones from the urinary bladder using a new instrument he invented—a lithotomy scalpel with two sharp cutting edges—and a new technique he invented—perineal cystolithotomy—which allowed him to crush a large stone inside the bladder, "enabling its piecemeal removal." This innovation was important to the development of bladder stone surgery as it significantly decreased the death rates previously caused by earlier attempts at this operation.
In the 1500s, Pierre Franco (1505-1578) was a pioneer in the suprapubic lithotomy method. Frère Jacques Beaulieu developed an operation that went in laterally to remove the bladder stones in the late 1600s. Beaulieu was a travelling lithotomist with scant knowledge of anatomy and a Dominican Friar. Beaulieu performed the frequently deadly procedure in France into the early 1700s.
The urologic community often claims Beaulieu is subject of the French nursery rhyme Frère Jacques, but this is not well-established. A possible connection between Frère Jacques and the Frère Jacques Beaulieu (also known as Frère Jacques Baulot) , as claimed by Irvine Loudon and many others, was explored by J. P. Ganem and C. C. Carson without finding any evidence for a connection. Some have suggested that Frère Jacques was instead written to mock the Jacobin monks of France (Jacobins are what the Dominicans are called in Paris).
Lithotomy was advanced in the 18th 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.
Notable people with bladder stonesNotable people who suffered from bladder stones include King Leopold I of Belgium, Emperor Napoleon Bonaparte, Emperor Napoleon III, Peter the Great, Louis XIV, George IV, Oliver Cromwell, Benjamin Franklin, the philosopher Sir Francis Bacon, the scientist Sir Isaac Newton, the civil servant and diarist Samuel Pepys, the physicians William Harvey and Herman Boerhaave, and the anatomist Antonio Scarpa.
Lithotomy in literature and popular cultureMuch of Neal Stephenson's Baroque Cycle is concerned with bladder stones, lithotomy and its aftermath, with several characters being forced to choose between the risky operation or death from bladder stones.
- Riches E. The history of lithotomy and lithotrity. Ann R Coll Surg Engl. 1968 Oct;43(4):185-99.