If you ask the average surgeon what he considers to be the greatest development in his profession in recent decades, he invariably says: laparoscopic surgery. Derived from the Greek words lapara (loin or the soft part of the body between ribs and hips) and kick end (looking or observing) it is the technique that is popularly known as keyhole surgery.
All in all, it is also very ingeniously conceived. You make a hole in the abdomen where you insert a tube (trocar called) and puts a rod-shaped camera with a beam of light through it. Subsequently, CO2 blown into the belly so that it takes the shape of a tennis hall. It is phenomenal what a view you have over all abdominal organs without having to cut the abdomen completely open.
Additional incisions
To be able to operate on someone’s inflamed appendix, gallbladder or colon cancer, you make a few extra incisions of about 5mm to insert and use your instruments. Much has changed since German surgeon George Kelling (1866-1945) first tried this procedure on his dog.
For those who are curious, there are thousands of videos online from all over the world, all with matching moody music, stuttering commentary or the professors themselves who proudly comment on their own work.
And so hundreds of techniques have been developed in this field and of course many types of instruments. Yet there are a few that are so good that they have hardly changed at all and are highly regarded by almost every surgeon. Also: the hook.
Especially in the hands of an experienced laparoscopic surgeon, the hook is a wonderful instrument
During an operation, even non-laparoscopic, we often work with diathermie. This technique, also invented by a German doctor (Karl Franz Nagelschmidt) in the early 1900s, generates heat by means of electromagnetic radiation with which you can cut tissue or cauterize small blood vessels. The hook is a rod-shaped instrument with, as the name suggests, a metal hook of about half a centimeter at the end. In the endoscopy superstore (never been to) is the cheapest around $200.
But certainly in the hands of an experienced laparoscopic surgeon, the hook is a wonderful instrument. You can use it to open a thin layer of the peritoneum in a super-selective way or to remove the gallbladder from its hole in the liver bed in exactly the right plane. A joy to work with and to watch.
Laparoscopy, and therefore also the hook, are now an indispensable part of our daily practice, but they represent a real revolution in surgery. A generation of young surgeons who had to convince the elderly that you could operate just as well ‘with those sticks in the stomach’. That was another ‘keyhole operation’.