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 changed little since Carl Langenbuch performed the first cholecystectomy, in Germany, 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. He removed a diseased gallbladder through an operating laparoscope of his own design, the galloscope, tying off the cystic structures with hemoclips from a pistol-grip applier and cutting between them with pistol-grip scissors. When he reported the operation to the German Surgical Society in 1986, he expected recognition. Instead, the society rejected his report. His 1990 paper to the American Journal of Surgery was also turned down, partly over his English. The society's recognition came on April 21, 1992, when it gave him its Anniversary Award and its president, Franz Gall, called the operation one of the greatest original achievements of German medicine in recent history.

Muhe performed 94 laparoscopic cholecystectomies before Philippe Mouret of Lyon did his first in 1987, followed by Francois Dubois of Paris in 1988; in the United States, J. Barry McKernan and William Saye performed the first on June 22, 1988, in Marietta, Georgia. Muhe never published his work in English, and in 1990 the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) honored Perissat, Berci, Cuschieri, Dubois and Mouret for early laparoscopic cholecystectomies but not him. In 1999 the same society recognized him as the first, inviting him to give its Storz Lecture.

Adoption after 1989 was rapid, and laparoscopic cholecystectomy soon displaced open surgery as the usual approach for symptomatic gallstones in industrialized countries. Patients went home sooner and returned to normal activity faster than after open surgery. 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 instruments. Muhe had designed his galloscope after four packages of gynecological endoscopic instruments arrived at the Boblingen County Hospital in 1984.