'Crushing the stone': a brief history of lithotripsy, the first minimally invasive surgery.

Overview

OBJECTIVE: To trace the history of lithotripsy, marking the start of minimally invasive surgery. METHODS: Primary and secondary sources describing the development of lithotripsy as a method to treat common bladder stones were reviewed. RESULTS: Lithotripsy emerged in the early 19th century as an alternative to the morbid and frequently fatal perineal lithotomy practised for thousands of years to relieve sufferers of bladder stones. Lithotripsy developed in stages, first by learning how to pass a straight hollow sound, then drilling stones to break them up, later by crushing them, followed by means to evacuate the fragments, finally by integrating the lithotrite with the cystoscope, permitting surgery under direct vision. CONCLUSIONS: Lithotripsy evolved as the first minimally invasive surgical procedure owing to the ingenuity and skill of our urological forebears.