Advances in Equine Laparoscopy E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: AVS - Advances in Vetinary Surgery
• Sprache: Englisch

Seitenzahl: 639

Veröffentlichungsjahr: 2012

Beschreibung

Part of the Advances in Veterinary Surgery series copublished with the ACVS Foundation and Wiley-Blackwell, Advances in Equine Laparoscopy presents a state-of-the-art reference on laparoscopic skills and procedures in the horse. Chapters are written by the leading experts in the field, and each section includes a practical review of the published literature. Encompassing instrumentation, basic principles, and specific techniques, Advances in Equine Laparoscopy offers an up-to-date, reliable resource for comprehensive information about equine laparoscopy. This current, well-referenced text begins with a section on the fundamentals of laparoscopy, then moves into sections on the clinical application of laparoscopic techniques in the standing or recumbent horse. A companion website offers eight video clips demonstrating selected procedures at www.wiley.com/go/ragle. Advances in Equine Laparoscopy is an invaluable guide for equine surgical specialists and equine clinicians interested in laparoscopic techniques.

Leseprobe

Table of Contents

Cover

Companion Website

Title page

Copyright page

Dedication

Contributors

Foreword

Foreword

Preface

Acknowledgment

Section I: Laparoscopic Skills and Instrumentation

1 Foundations of Laparoscopy

Origins of laparoscopy

Subsequent developments

Rapid growth of human laparoscopy

Evolution of equine laparoscopy

2 Fundamental Laparoscopic Skills

Introduction

3 Suturing and Knot-Tying Techniques

Introduction

Preparation for suturing

Instrumentation and suture

The simple stitch

Introduction of the needle and suture into the body and loading of the needle holder

Passing the stitch

Endo Stitch®

Tying the knot

Acknowledgment

Videos available online

4 Fundamentals of Energy Sources

Introduction

Thermal effects in tissue

Electrocautery technology

Electrosurgical technology

Ultrasonic technology

Laser technology

Safe application of thermal energy in surgery

Conclusions

5 Reusable Equipment

Introduction

Endoscope system

Telescopes and instruments

Electromechanical devices

Imaging systems

The future

6 Disposable Equipment

Introduction

Insufflation

Ports

Tissue manipulation

Fixation

Energy-based devices

Specimen retrieval

Section II: Laparoscopy in the Standing Horse

7 Sedation and Analgesia in the Standing Horse

Introduction

Sedative and analgesic drugs (dosages in Table 7.1)

Techniques

Physiological changes and monitoring

Postoperative pain

8 Diagnostic Techniques

Introduction

Standing surgery

Dorsally recumbent surgery

Postoperative management

Conclusion

9 Evaluation of Horses with Signs of Acute and Chronic Abdominal Pain

Introduction

Equipment

Instruments

Indications for laparoscopy

Laparoscopy for acute signs of abdominal pain

Laparoscopy for chronic signs of abdominal pain

Complications with laparoscopy for acute or chronic signs of colic

Discussion

Videos available online

10 Closure of the Nephrosplenic Space

Introduction

Surgical procedure

Postoperative care

Discussion

11 Adhesiolysis

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

12 Mesenteric Rent Repair

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

13 Cryptorchidectomy

Introduction

Anesthesia

Surgical procedure

Extracorporeal emasculation

Suture loop technique

Electrosurgical instrumentation

LigaSure instrumentation

Postoperative management

Conclusion

14 Peritoneal Flap Hernioplasty Technique for Preventing the Recurrence of Acquired Strangulating Inguinal Herniation in the Stallion

Introduction

Anesthesia, positioning, and surgical preparation

Preoperative preparation

Surgical procedure

Postoperative care

Conclusion

15 Inguinal Hernioplasty Using Cyanoacrylate

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

16 Intersex Gonadectomy

Introduction

Anesthesia, positioning, and surgical preparation

Surgery

Instrumentation

Postoperative management

Conclusion

17 Bilateral Ovariectomy in the Mare

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

18 Ovariectomy for the Removal of Large Pathologic Ovaries in Mares

Introduction

Anesthesia, positioning, and surgical preparation

Preoperative preparation

Surgical procedure

Postoperative care

Complications

Outcome

Conclusion

19 Imbrication of the Mesometrium to Restore Normal, Horizontal Orientation of the Uterus in the Mare

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

20 Nephrectomy

Introduction

Surgical procedures

Postoperative care

Complications

Discussion

21 Repair of the Ruptured Equine Bladder

Introduction

Anesthesia, positioning, and surgical preparation

Surgery

Postoperative management

Conclusion

22 Equine Thoracoscopy

Introduction

Instrumentation

Pathophysiology

Sedatives, anesthetics, and analgesia in thoracoscopy

Exploratory thoracoscopy

Thoracoscopic-assisted biopsy

Thoracoscopy in pleuritis and pneumonia

Thoracoscopy in chest trauma

Complications

Conclusions

Section III: Laparoscopy in the Recumbent Horse

23 General Anesthesia in the Recumbent Horse

Introduction

Preparation for anesthesia

Premedication (dosages in Table 23.1)

Induction to anesthesia (dosages in Table 23.2)

Maintenance of anesthesia

Analgesia

Recovery from anesthesia

24 Colopexy

Introduction

Patient selection

Preoperative management

Surgical technique

Postoperative management

Complications

Summary

25 Mesh Incisional Hernioplasty

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

26 Cryptorchidectomy

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

27 Inguinal Hernioplasty

Introduction

Anesthesia, positioning, and surgical preparation

Instruments

Surgery

Postoperative management

Conclusion

Acknowledgment

28 Inguinal Herniorrhaphy in the Foal

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

29 Ovariectomy in the Mare

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Complications

Conclusions

30 Ovariohysterectomy in the Mare

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgery

Postoperative management

Conclusion

31 Laparoscopic- and Endoscopic-Assisted Removal of Cystic Calculi

Introduction

Surgical procedures

Postoperative care

Complications

Discussion

32 Splenectomy

Introduction

Anesthesia, positioning, and surgical preparation

Instrumentation

Surgical technique

Postoperative management

Procedure-related complications and patient outcomes

Limitations of the available literature

33 Hand-Assisted Laparoscopy

Index

This book is accompanied by a companion website:

www.wiley.com/go/ragle

The website includes:

Video clips demonstrating selected techniques

This edition first published 2012 © 2012 by John Wiley & Sons, Inc.

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Library of Congress Cataloging-in-Publication Data

Advances in equine laparoscopy / edited by Claude Ragle.

p. ; cm. – (Advances in veterinary surgery)

 Includes bibliographical references and index.

 ISBN 978-0-470-95877-3 (hardcover : alk. paper) 1. Horses–Surgery. 2. Horses–Diseases–Diagnosis. 3. Veterinary laparoscopic surgery. I. Ragle, Claude. II. Series: Advances in veterinary surgery.

[DNLM: 1. Horse Diseases–surgery. 2. Horses–surgery. 3. Laparoscopy–methods. 4. Laparoscopy–veterinary. SF 951]

SF951.A38 2012

636.1’0897–dc23

2012014116

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design by Garth Stewart

Disclaimer

The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation warranties of fitness for a particular purpose. No warranty may be created or extended by sales or promotional materials. The advice and strategies contained herein may not be suitable for every situation. This work is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. If professional assistance is required, the services of a competent professional person should be sought. Neither the publisher nor the author shall be liable for damages arising herefrom. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read.

Dedication

This book is dedicated to my colleagues in laparoscopy who shared so generously to enrich our knowledge to care for the horse.

Contributors

Josef Boening, DVM, DECVSTierarztliche Klinik, Telgte, Germany

Palle Brink, DVM, DECVSJägersro Equine ATG Clinic, Jagersro, Malmo, Sweden

John P. Caron, DVM, MS, DACVSCollege of Veterinary Medicine, Michigan State University, East Lansing, MI

Christopher J. ChamnessKarl Storz Endoscopy, Director of Global Business Development-Veterinary, Santa Barbara, CA

Kayla Cochran, DVMCollege of Veterinary Medicine, Colorado State University, Fort Collins, CO

Ted Fischer, DVM, DACVSChino Valley Equine Hospital, Chino Hills, CA

Boel A. Fransson, DVM, PhD, DACVSCollege of Veterinary Medicine, Washington State University, Pullman, WA

Tamara Grubb, DVM, MS, DACVACollege of Veterinary Medicine, Washington State University, Pullman, WA

Dean A. Hendrickson, DVM, MS, DACVSCollege of Veterinary Medicine, Colorado State University, Fort Collins, CO

John C. Huhn, DVM, MSVeterinary Medical Director, Covidien Animal Health, Salem, CT

Andreas Klohnen, DVM, DACVSChino Valley Equine Hospital, Chino Hills, CA

Monika Lee, BSCollege of Veterinary Medicine, Colorado State University, Fort Collins, CO

Céline Mespoulhes-Rivière, DVM, DECVSEcole Nationale Vétérinaire d′Alfort, Maisons-Alfort Cedex, France

Scott E. Palmer, VMD, DABVPNew Jersey Equine Clinic, Millstone Twp, NJ

John Peroni, DVM, MS, DACVSCollege of Veterinary Medicine, University of Georgia, Athens, GA

Claude A. Ragle, DVM, DACVS, DABVP-EPCollege of Veterinary Medicine, Washington State University, Pullman, WA

Michael Roecken, DVM, Priv.-Doz.Veterinary Clinic Starnberg, Starnberg, Germany; Department of Equine Surgery, School of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany

Dwayne H. Rodgerson, DVM, MS, DACVSHagyard Equine Medical Institute, Lexington, KY

Fabrice Rossignol, DVM, DECVSClinique de Grosbois, Boissy Saint Leger, France

Jim Schumacher, DVM, MS, MVB, DACVSCollege of Veterinary Medicine, University of Tennessee, Knoxville, TN

John Schumacher, DVM, MS, DACVIM, ABVPCollege of Veterinary Medicine, Auburn University, Auburn, AL

Ceri Sherlock, DVM, DACVSCollege of Veterinary Medicine, University of Georgia, Athens, GA; School of Veterinary Medicine and Science, Sutton Bonington Campus, University of Nottingham, Sutton Bonington, Leicestershire, LE12 5RD, England

Donna L. Shettko, DVM, DACVSCollege of Veterinary Medicine, Western University of Health Sciences, Pomona, CA

Hans Wilderjans, DVM, DECVSDierenkliniek De Bosdreef, Moerbeke-Waas, B-9180, Belgium

David G. Wilson, DVM, DACVSWestern College of Veterinary Medicine, University of Saskatchewan, Sasketchewan, Canada

Foreword

Advances in Equine Laparoscopy is a textbook that will be welcomed by all equine laparoscopic surgeons. Since the 1980s, when merely examining the equine abdomen endoscopically was an exciting revelation, some techniques such as laparoscopic ovariectomy and cryptorchidectomy have developed and matured to become the treatment of choice for most surgeons. By 2012, however, a wide range of laparoscopic procedures have been reported and a publication conflating all this information is most appropriate.

In the human field, despite several reports of endoscopic procedures in the nineteenth century, the received birthplace of laparoscopy was in Dresden in 1901 when George Kelling examined a dog’s abdomen using a Nitze cystoscope; this was followed by endoscopic examinations of the human abdomen. As early as 1927, the first human laparoscopic textbook, Lehrbuch und Atlas der Laparo- und Thorakoskopie by Korbsch, was printed. Another significant early contributor was Heinz Kalk, who developed new lens systems in 1929 and published widely on liver and gall bladder disease. Progress predicated not only on the ambition of surgeons but also on technological developments. It was not until the late 1960s that the real expansion of laparoscopy began when Steptoe’s Laparoscopy for Gynaecology, describing laparoscopic sterilization techniques, instrumentation, and the use of electrocoagulation, was published. In the 1970s, over 250,000 laparoscopic sterilizations were performed annually in the United States, but there was little formal training and complication rates were high. As a result, the American Association of Gynecologic Laparoscopists was founded to inform surgeons and to monitor complications, and at about the same time, Chamberlain and Brown (1978) in Britain analyzed prospectively the complication rate in 50,000 laparoscopies. Gradually, an evaluation of what was going wrong and the introduction of credentialing programs has led to a reduction in morbidity and mortality in human laparoscopy.

There are other influences on the use of new techniques: One is the kudos of being able to perform them and another is public pressure for them to be performed, neither driven by the most important indication, viz, the outcomes of the procedures. In human surgery, Cameron and Gadacz (1991) considered these influences a factor in the high incidence of bile duct injuries in laparoscopic cholecystectomies, which were 10 times that of open surgery. Nowadays, medical laparoscopy is under constant review and boasts many laparoscopic procedures that have proven benefits over open surgery.

Laparoscopy has been a stimulating and challenging addition to the veterinary surgeon’s repertoire and as a veterinary discipline it is scarcely 25 years old. As with other fields of surgery, the development of veterinary laparoscopy has followed that of human laparoscopy but has progressed more slowly. The size of the horse’s abdomen and the weight of some abdominal organs have restricted the range of possible procedures. Like human surgeons in the early days, those of us performing equine laparoscopies in the late 1980s had little guidance and progress was slow, even though our arthroscopic hand–eye skills possibly gave us a better start than our human colleagues who at first only had training in general surgery. There are few studies analyzing morbidity and mortality associated with equine laparoscopy. Anecdotally, high complication rates do not seem to have been the problem they were in human surgery: Perhaps they just have not been reported or maybe we have learned from the human experience. Either way, analysis of complication rates is called for, but at least formal laparoscopic tuition is now available and has become part of the residents’ training program so we can hope that many of the pitfalls will be avoided.

No doubt we also have been driven to perform laparoscopies for the benefit of our image as state-of-the-art surgeons, a fatal trap if our technique is insecure or if there are no benefits to the horse over open surgery. Client pressure can be difficult to ignore or assuage and can also lead us into performing procedures beyond our capabilities. For the benefit of our patients and ultimately their owners, we have a responsibility to evaluate our outcomes; comparative studies that will prove or disprove the benefits of procedures being performed laparoscopically are sorely needed. Once we have this information, we are in a stronger position to advise owners on the best course of action and we are unlikely to perform a laparoscopy because it is fun to do but has no benefit.

A great contribution to the discipline was made when in 2002 Ted Fischer’s landmark textbook, Equine Diagnostic and Surgical Laparoscopy, was published giving equine laparoscopists confidence to increase their repertoire and to consolidate their experience. This new text, Advances in Equine Laparoscopy, is the fruition of these experiences. Despite its title, the basics are not forgotten. The critical appraisal of training methods is a reminder that certain skills are difficult to acquire and there are many ways to learn them. Laparoscopic skills are some of the most difficult to master in the field of surgery, and a basic competence in instrument and tissue handling in a 3-D cavity with 2-D vision is absolutely essential. Laparoscopic knots cannot be learnt during surgery nor can intracorporeal suturing and knot tying, two famously difficult techniques to master. However since they may be needed in a crisis, especially when hemorrhage is involved, they must be part of the surgeon’s armory before he or she embarks on laparoscopy in the clinical patient. This book offers the opportunity for the inexperienced to discover what there is to learn and how to go about it, and for the experienced it is a reminder to maintain their skills. The thorough coverage of most procedures in common use today provides a basis and, one would hope, a stimulus for comparative studies between open surgery and laparoscopy. It is a reflection of the acceptance of equine laparoscopy that the evaluation of open techniques may have to be retrospective for some procedures. However, an objective appraisal is called for and where enough studies are published even a meta-analysis would be useful.

The time is opportune for a text that not only consolidates our knowledge of the bread-and-butter laparoscopic procedures, such as ovariectomy and cryptorchidectomy, but also offers detailed accounts of those that are proving their efficacy such as closure of the nephrosplenic space and herniorrhaphy. More advanced procedures including nephrectomy, splenectomy, cystotomy, and ovariohysterectomy are also covered. Written by surgeons with good experience of the techniques, this book will facilitate a widening of the laparoscopic repertoire and encourage experienced surgeons to master advanced techniques. Laparoscopy is an unforgiving activity that depends on good technique, and a study of this book will enable surgeons to avoid the mistakes of their predecessors, progress more safely, and benefit the horse and its owner. The skill, knowledge, and judgment of the surgeon are the factors on which the success of surgical procedures depends. Advances in Equine Laparoscopy will enhance the quality of all three and will make a significant contribution to the development of this discipline.

John P. Walmsley, MA, VetMB, CertEO,DipECVS, HonFRCVSThe Liphook Equine HospitalForest MereLiphookHants GU30 7JGUK

References

Cameron, J.L. & Gadacz, T.R. (1991) Laparoscopic cholecystectomy (Editorial). Annals of Surgery, 213, 1–2.

Chamberlain, G. & Brown, J.C. (eds.) (1978) Gynaecological Laparoscopy: Report on the Confidential Enquiry into Gynaecological Laparoscopy. Royal College of Obstetricians and Gynaecologists, London.

Foreword

The American College of Veterinary Surgeons (ACVS) Foundation is excited to present Advances in Equine Laparoscopy as the second book in the book series Advances in Veterinary Surgery. The ACVS Foundation is an independently chartered philanthropic organization devoted to advancing the charitable, educational, and scientific goals of the ACVS. Founded in 1965, the ACVS sets the standards for the specialty of veterinary surgery. The ACVS, which is approved by the American Veterinary Medical Association, administers the board certification process for diplomates in veterinary surgery and advances veterinary surgery and education. One of the principal goals of the ACVS Foundation is to foster the advancement of the art and science of veterinary surgery. The Foundation achieves these goals by supporting investigations in the diagnosis and treatment of surgical diseases; increasing educational opportunities for surgeons, surgical residents, and veterinary practitioners; improving surgical training of residents and veterinary students; and bettering animal patients’ care, treatment, and welfare. This collaboration with Wiley-Blackwell benefits all who are interested in veterinary surgery by presenting the latest evidence-based information on a particular surgical topic.

This edition is an outstanding example of the promise of this series. Advances in Equine Laparoscopy is edited by Dr. Claude A. Ragle, a diplomate of the ACVS and a prominent equine surgeon. He has assembled the leaders in the field of equine laparoscopy presenting the important techniques and applications for this minimally invasive procedure. As you read through this book, you will find the latest information on the foundations and fundamental skills required for laparoscopy, equipment, techniques for sedation and analgesia required for the use of laparoscopy in horses, and the techniques and applications for a wide range of laparoscopic and thoracoscopic procedures. The ACVS Foundation is proud to partner with Wiley-Blackwell on this important series and is proud to present this second book in the series Advances in Veterinary Surgery.

Mark D. MarkelChair of the Board of TrusteesACVS Foundation

Preface

Advances in Equine Laparoscopy (AEL) represents an important update in the practice of minimally invasive surgery (MIS) of the horse. It has been more than three decades since the publication of Animal Laparoscopy, the first veterinary laparoscopy book in which Dr. Witherspoon and colleagues described the basic technique and instrumentation for the laparoscopy of the horse. Ten years separate this publication of AEL from Equine Diagnostic and Surgical Laparoscopy, the first book dedicated to the topic of laparoscopy of the horse. AEL builds upon the stellar contributions of these preceding books. It represents a collaborative gathering of current advances in techniques and instrumentation and is designed to augment and contrast existing texts. The book is organized such that the first several chapters review the fundamental foundations of equine laparoscopy. The following chapters are clinical techniques and are divided into groups based on standing or recumbent positioning of the horse and then on the body system being operated where applicable. A chapter reviewing sedation, analgesia, and/or anesthesia of the horse for laparoscopy precedes each of the two groups of chapters that are based upon the horse’s position during the operation. Each operative technique chapter follows a general framework to provide continuity and to ease locating of information by the reader. This scheme of organization inherently leads to some overlap between related techniques but importantly provides the reader a broader perspective in how clinical experts may approach similar operative challenges in another way. With few exceptions, every technique presented is a procedure that is a current standard of practice in laparoscopy. Not included in this edition of AEL are areas of MIS that are still in their infancy in equine surgery, such as Single Incision Laparoscopic Surgery (SILS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Laparoscopic Robotic Surgery; it is anticipated that progress in these techniques in the horse may warrant inclusion in a future edition. This book will be of great interest to all that are interested in the field of MIS and provides an excellent platform for the future advancement of equine laparoscopy.

Acknowledgment

It is with great appreciation I recognize the ACVS Foundation’s Board of Trustees and Dr. Mark Markel (Chair) for creating the Advances in Veterinary Surgery series of books and for recognizing the significant progress of laparoscopy in equine surgery. This book would not have been possible without the expert guidance of Erica Judisch and Susan Engelken of Wiley-Blackwell. I also acknowledge Rachael Lencioni, veterinary student extraordinaire, for her tireless efforts and organizational skills working on this book, and Dr. William Dernell, my department chair, for his encouragement. Finally, I would like to acknowledge my extended family and friends, particularly, Boel and my two wonderful daughters, Selma and Ella, for their unconditional love.

Section ILaparoscopic Skills and Instrumentation

1 

Foundations of Laparoscopy

John P. Caron

Origins of Laparoscopy

Since antiquity, health-care providers have striven to visually examine the internal anatomy of their patients. Indeed, rectal specula and natural light were in use in the era of Hippocrates of Cos (Rosin 1993). Ambient light or external light sources supplemented with diverse lenses or mirrors to examine the ears, nose, mouth, rectum, and vagina/uterus were used until the mid-nineteenth century. Among the first using artificial light was the lichtleiter or “light transmitter” invented by the German physician Philip Bozzini in 1804. The light source for the device was a wax candle, and its glow was reflected by a mirror into a speculum that Bozzini used for the examination of a variety of body orifices and the uterus (Figure 1.1). Unfortunately, as a result of contemptuous reviews of his invention by his contemporaries, the innovation went largely unrecognized by the medical community (Rathert et al. 1974). Perhaps inspired by the work of Bozzini, in 1853, Antonin Desormeaux developed an “endoscope” with a lamp fueled by a mixture of turpentine and alcohol (Kaiser & Corman 2001). The light from the flame was concentrated and directed by a concave mirror to the area of interest and permitted evaluation of the cervix, uterus, and urinary bladder, although it lacked sufficient light for gastroscopy (Figure 1.2) (Rosin 1993; Lau et al. 1997). Unlike the reproach Bozzini’s efforts engendered, Desormeaux received an award from the Royal Academy of Medicine in Paris and went on to use his endoscope for diagnostic and therapeutic procedures in his practice at the Necker Hospital in Paris during the 1860s (Kaiser & Corman 2001).

Figure 1.1 Illustration of the lichtleiter of Philip Bozzini. The light from the candle is reflected by a mirror through an attached speculum (not shown) into the patient.

Source: National Library of Medicine.

Figure 1.2 Diagram of Antonin Desormeaux’s endoscope of 1853. A lamp fueled by turpentine and alcohol provided the artificial light that was focused and directed through the speculum.

Source: National Library of Medicine.

The first endoscope with an internal light source was the invention of a German dentist, Julius Bruck, in 1867 (Figure 1.3) (Rosin 1993). The light source was an electrically heated platinum wire, which provided improved illumination but generated considerable heat. The potential for tissue burns induced by the instrument was reduced with the addition of a circulating water jacket. Maximilian Nitze, a German urologist, and his colleagues are generally credited with the development of the first rigid telescope in 1879, an instrument equipped with a series of lenses and a light source based on the design of Bruck (Figure 1.4) (Nitze 1879). Following the invention of the incandescent bulb by Thomas A. Edison in 1880, it was incorporated into a telescope developed by the Glaswegian David Newman in 1883 (Dameword 1992). Further developments in lenses and miniaturization of incandescent light bulbs fostered additional advances so that endoscopy of the upper airway, lower urogenital tract, esophagus, stomach, and anorectum began to be conducted with some frequency. Although the thoracic and peritoneal cavities were yet to be examined, the equipment and methodology to do so was largely in place (Lau et al. 1997).