From ‘stone cutting’ to high-technology methods: The changing face of stone surgery

The surgical management of urolithiasis, in particular cystolithiasis, has been known for more than two millennia. The term lithotomy was first used by the Greek surgeon Ammonius (276 BCE), but the practice of cutting the stone would have existed long before that. However, Hippocrates (460 BCE) discouraged the procedure. His oath reads: ‘I will not cut persons labouring under the stone, but will leave this to be done by practitioners of this work’. Most probably he wished to disassociate himself from this frequently unsuccessful procedure, in an attempt to prevent it from tarnishing the physicians’ reputation. The Roman physician Celsius (25 BCE–25 CE) provided the earliest proper description of a lithotomy procedure for bladder stones. Notably, his description remained broadly accurate for the techniques used over the next 1500 years. The procedure remained associated with a relatively poor success rate, with frequent and often unpleasant complications, such as damage to the rectum or bladder, and death. Only over the last 150 years, with the techniques of asepsis and anaesthesia, has more complex surgery become possible. For almost all stones in the urinary tract, open surgical procedures have been developed and applied. The invention of cystoscopy allowed the endoscopic removal of bladder stones [1]. Then, over the last three decades the development of endourological and nonsurgical less-invasive techniques, such as ESWL, percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible retrograde intrarenal surgery, and (more recently but to a lesser extent) laparoscopy, have revolutionized stone treatment and led to a marked decrease in the need for open stone surgery [2,3].