Lithotomy

Lithotomy from Greek for "lithos" (stone) and "tomos" (cut), is a surgical method for removal of calculi, stones formed inside certain organs, such as the kidneys (kidney stones), bladder (bladder stones), and gallbladder (gallstones), that cannot exit naturally through the urinary system or biliary tract. The procedure, which is usually performed by means of a surgical incision (therefore invasive), differs from lithotripsy, wherein the stones are crushed either by a minimally invasive probe inserted through the exit canal, or by an acoustic pulse (extracorporeal shock wave lithotripsy), which is a non-invasive procedure.

History

Human 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). 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, as distinct from physicians. Operations to remove bladder stones via the perineum, like other surgery before the invention of anesthesia, were intensely painful for the patient.