Surgery & Anesthesia · 1985
First Laparoscopic Cholecystectomy
By the mid-1980s, cholecystectomy meant a right subcostal incision long enough to deliver a gallbladder through a small space, several days in hospital, and a convalescence measured in weeks. The operation was safe in experienced hands and had been performed in essentially the same way since Carl Langenbuch removed the first gallbladder in Berlin in 1882. Laparoscopes existed and were used routinely in gynecology for diagnostic procedures and tubal ligation, but the idea of using them for abdominal organ removal had not been translated into surgical practice in general surgery.
Erich Muhe, a general surgeon in Boblingen, Germany, made that translation on September 12, 1985. Working through two small abdominal ports rather than a wide incision, he removed a diseased gallbladder using an instrument of his own design that he called the Galloscope. The operation was completed without complication. Muhe brought his results to the German Surgical Society, anticipating recognition of a technical advance. Instead, the society rejected his report. A formal complaint was lodged against him, and he faced a period of professional censure that lasted years. Official recognition from the German Surgical Society did not come until 1992.
While Muhe was navigating the complaint process, French surgeons Philippe Mouret, Francois Dubois, and Jacques Perissat independently developed and began performing laparoscopic cholecystectomy using video-assisted techniques with standard laparoscopic instruments, and American surgeons were doing the same by the late 1980s. Their more accessible publications and training workshops accelerated uptake in ways Muhe's rejected report had not. The historical record of who was first was eventually settled in Muhe's favor, but the dissemination of the technique owed more to the French and American work than to his original procedure.
Adoption after 1989 was among the fastest in modern surgical history. Within three to four years, laparoscopic cholecystectomy had displaced open surgery as the default approach for symptomatic gallstones at most centers in the industrialized world. Patients left hospital within one to two days rather than five to seven, and returned to normal activity within a week. The training infrastructure adapted accordingly: residency programs redesigned cholecystectomy as a laparoscopic procedure from the start, and open cholecystectomy became a skill taught primarily for conversion situations.
The consequences extended well beyond biliary surgery. Proof that a major abdominal organ could be safely removed through small ports prompted exploration of the same approach for appendectomy, inguinal and ventral hernia repair, colectomy, fundoplication, and adrenalectomy. Each operation required its own learning curve and instrument adaptation, but laparoscopic cholecystectomy had established the conceptual and technical foundation. Muhe's 1985 operation, initially dismissed by the society that should have recognized it first, became the reference point from which minimally invasive abdominal surgery dates its origins.
Key People
- Erich Muhe — German surgeon who performed the first laparoscopic cholecystectomy in 1985
- Philippe Mouret — French surgeon who independently performed early video-laparoscopic cholecystectomy in 1987
- Francois Dubois — French surgeon who published and trained widely in laparoscopic cholecystectomy technique
- Jacques Perissat — French surgeon who contributed to early laparoscopic technique and its dissemination
JSLS, 2001
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