Figure 5. A prototype of Frangenheim's Insufflator (1959). (Figure 5-3 in Highlights in the History of Laparoscopy.) Figure 4. Hans Frangenheim (b. 1920). (Figure 5-2 in Highlights in the History of Laparoscopy.) Hans Frangenheim (b. 1920), son of a professor of surgery in Cologne, was fortunate enough to spend the first years of National Socialist rule outside Germany. At age eleven, his parents sent him to a Swiss boarding school, where he stayed until 1938.13 Before he took up medical studies in 1942 at the university in Munster, he did military and labor service training with the German air force. After the war, Frangenheim worked in an American military hospital. In 1946, he moved to a German university clinic for surgery. Four years later he started his training in gynecology at a women's clinic in Wuppertal. In 1951, an internist at the Wuppertal Clinic happened to notice a tumor in the lower abdomen of a female patient during a liver laparoscopy and called in Frangenheim for assistance. As Frangenheim recalls, "I realized that this could mean a new aid for gynecology and I began to look into the literature."15 He started to modify laparoscopic instruments to accomplish gynecological tasks, and a year later was performing laparoscopic examinations on a regu- lar basis. He could not find any reports on endoscopy in gynecology except for culdoscopy. "At that time I did not have any idea of Palmer and I relied completely on Kalk's work," notes Frangenheim (Figure 4).14 In contrast to many of his colleagues, Frangenheim was not satisfied with culdoscopy and turned to an abdominal approach. He soon came across Palmer's articles on steril- ity and coelioscopy in the French medical press. As Palmer's guest book in Paris indicates, Frangenheim paid Figure 6. The "cold light" principle. (Figure 5-5 in Highlights in the History of Laparoscopy) his first visit in October 1955 —the beginning of a life-long cooperation and friendship between the Palmers and Frangenheim.16 Within two and a half years, Frangenheim had performed over 350 endoscopic examinations. His first article for the medical press appeared in 1958 and included a summary of the spread of endoscopy in Europe.17 "Following Decker's recommendations, the university clinics for gynecology in Hamburg, Leipzig, Kiel, and Heidelberg ... have given almost unanimous endorsement to the culdoscopy ... for the endoscopic examination of the abdominal cavity," he wrote. Frangenheim noted that only Palmer in Paris, Guggisberg in Bern, and Schwalm in Mainz had used laparoscopy. He left open the issue whether culdoscopy or laparoscopy was to be the method of choice for gynecology. Frangenheim's Insufflator In the late 1950s, internists were still using atmospheric air injected via a needle to insufflate the stomach cavity. Two hundred or 500 cc of air was employed to provide pneu- moperitoneum. Frangenheim recognized the need to improve this technique and decided to build an insufflator. He presented a prototype of his device in 1959: "Until recently, we had introduced CO2 into the stomach cavity with an anesthetic device from the Draeger-Werke, and turned on a simple blood-pressure apparatus .... At our request, the Draeger-Werke constructed a simple, handy device to replace this makeshift one; a built-in safety valve avoids any insufflation with a pressure of over 250 mm Hg."18 Despite such precautions, Frangenheim recom- mended that the gas pressure in the stomach cavity "per findings by Decker and Palmer, was not to exceed 30-40 mm Hg ... otherwise irritations to the peritoneum arise" (Figure 5) JSLS (1997)1:357-361 359