PROFILES IN LAPAROSCOPYJSLS Hans Frangenheim - Culdoscopy vs. Laparoscopy, the First Book on Gynecological Endoscopy, and "Cold light" Grzegorz S. Litynski ABSTRACT In the United States, culdoscopy (a vaginal approach to view the abdomen) replaced laparoscopy for about 20 years, circa 1950-1970. In contrast to many of his col- leagues, Hans Frangenheim of Wuppertal, Germany, was not satisfied with culdoscopy and turned to an abdominal approach. Frangenheim began publishing his experiences with gynecological laparoscopy in 1958 and stressed tech- nical improvements. He constructed a CO2 insufflator, wrote the first book on gynecological endoscopy, and introduced "cold light" into laparoscopy. Frangenheim strongly stimulated the rise of gynecological laparoscopy in Europe in the 1960s and later. Per Vaginum Into the Abdomen Vaginal operations are even older than the introduction of anesthesia. Scholars assume that the first successfulvaginal hysterectomy was performed in 1822 by Johann Nepomuk Sauter (1766-1840). Joseph Claude Recamier (1744-1856) followed in 1824, and Bernhard Rudolf Langenbeck (1810- 1887) performed the operation nineteen years later. The Parisian surgeon Jules Pean (1830-1898) also gathered extensive experience in operations with the vaginal approach.1 The vaginal operation became better known in German- speaking areas with the work of Vinzenz Czerny (1842- 1916), who described the vaginal hysterectomy in 1879.2 In the 1890s, operations per vaginum had become so "popu- lar," wrote the Breslau gynecologist, Baumm, "that in recent years, one has literally set one's heart on attacking all pos- sible maladies of the female genitalia, for which until recently one had considered only the laparotomy, from the vagina."3 Over the course of time, more and more voices spoke out against colpotomy, both anterior and posterior, in detailed discussions about a vaginal approach for oper- ating. The Berlin gynecologist Robert Olshausen, for exam- Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. Address reprint request to: Grzegorz S. Litynski, Klinikum der J.W. Goethe-Universitat, Institut fur Geschichte der Medizin, Paul Ehrlich Str. 20-22, 60590 Frankfurt/Main, Germany. E-mail: glitynski@aol.com; Fax: +49 69 6860 9192 ple, demanded that "we finally build a common front against the senseless and dangerous expansion of the colpotomy."4 Rudolf Chrobak (1843-1910), of Vienna, cau- tioned, "One can not always recognize the injuries which arise from the operation, while such injuries with laparo- tomies can be discovered immediately, and the necessary steps taken."5 Johannes Pfannenstiel (1862-1909), also from Breslau, added his own council: "As a result of today's almost 0% mortality, we have certainly no higher death rate here than when we operate vaginally."6 Beginning in 1891, Dimitri Oskarovic von Ott (1855-1929), a Russian gynecologist from St. Petersburg, utilized normal incandescent light with a reflector for gynecological opera- tions. The light was fastened to the forehead with a band (Figure 1). He also attached a mirror to the light, adjustable to the demands of the examination at hand.7 Ott most frequently used "ventroscopy" for the postoperative examination of gynecological operations. In 1903, Ott reported on more than 606 operations carried out per vaginum.8 With advances in anesthesia and asepsis, the risks of abdominal operations decreased so radically that around 1900 the mortality rate of both vaginal and abdominal oper- ations hovered around five percent. Vaginal access thus no longer offered significant advantages, and discussion pro- moting vaginal approaches soon faded.9 Culdoscopy In the late 1920s, Albert Decker, a surgeon at the Knickerbocker and Gouverneur Hospital in New York, began to use a peritoneoscope for viewing the abdominal cavity. "I started coelioscopy in 1928 and worked with it for ten or eleven years before giving it up," he noted.10 Decker was aware that another physician, Ruddock, in California, was performing coelioscopies as well, but decided against pursuing this direction. "I gave up coelioscopy because it required general anesthesia," he recalled. "[A]nd I gave up doing any operative procedure through the coelioscopy because with a good anesthesia and the use of an operat- ing room, I felt it was just as well to explore the abdomen and find out what was wrong, and at the same time correct the condition properly." JSLS (1997)1:357-361 357