History
The History of Microsurgery in Urology
Alexander W. Pastuszak, Evan P. Wenker, and Larry I. Lipshultz
A BRIEF HISTORY OF MAGNIFICATION IN
MEDICINE
T
he principle of magni
f
cation is fundamentally
based on light refraction; by placing an object
between 1 and 2 focal lengths from the retina, a
magnifying lens can enlarge the object
’
s appearance while
maintaining resolution.
1
Archimedes is credited with the
invention of the
“
burning glass,
”
a series of lenses used to
focus the sun
’
s rays on enemy ships, causing them to catch
f
re. The Roman Claudius Ptolemaeus described and
calculated light refraction by water, whereas Seneca and
the English philosopher Roger Bacon reported the
magni
f
cation of text by looking through a water-
f
lled
sphere.
2
Ibn al-Haytham furthered the understanding of
human vision with descriptions of ocular anatomy,
function, and visual principles in his
Opticae Thesaurus
,
3
leading to the introduction of eyeglasses in the late
13th century by Italian monks who could grind glass.
3
As
early as the 1500s, surgical technique began focusing on
f
ner work. When Andreas Vesalius
f
rst described
the abdominal aortic aneurysm in the Netherlands
4
during the 16th century, European battle
f
eld surgeons
treated vascular injuries through ligature and vascular
suturing, albeit rarely with success and always without
magni
f
cation.
5
The
f
rst compound microscopes are attributed to the
Dutch spectacle makers Hans Jansen, Zacharias Jansen,
and Hans Lippershey, who around 1590 discovered that
objects could be magni
f
ed using elongated telescope
tubes.
2
Soon after, Galileo studied small objects using a
similarly adapted telescope. He was a member of the
“
Accademia dei Lincei
”
in Rome, whose members
f
rst
coined the term
“
microscopium.
”
2
In England, Robert
Hooke used a compound microscope to discover and
describe the cell, whereas the Italian optician Giuseppe
Campani examined wounds and scars.
3,6
In 1677, a
medical student, Johann Ham, discovered spermatozoa
in the ejaculate of a patient with gonorrhea. He reported
his
f
ndings to the Dutch scientist Antonie van Leeu-
wenhoek, who performed extensive studies on seminal
fl
uid, reporting his results in
>
150 letters to the Royal
Society in London.
7
As pathology became increasingly important to surgical
practice during the late 19th century, surgeons used
magni
f
cation to facilitate tissue dissection. Charles Louis
Chevalier, a French optician,
f
rst constructed a loupe
that could be used during surgery, magnifying objects
10 fold at a 7-cm distance. In 1886, Carl Wilhelm
von Zehender, a German ophthalmologist, modi
f
ed a
zoologic binocular and placed it on a tripod, creating a
prototype surgical microscope and the forerunner of the
slit-lamp.
2
Although von Zehender
’
s binocular was too
big for use in the operating room, in 1912, the Zeiss
Company introduced a lighter binocular set of operating
loupes worn like glasses.
2
In 1923, the Leitz Company
introduced a prismatic loupe, which permitted beam
splitting, allowing assistants to share the same view as the
surgeon,
2
facilitating teaching of surgical technique and
photographic image capture. In the spring of 1921, the
otorhinolaryngologist Carl Olof Nylen performed the
f
rst
ear operation using a modi
f
ed monocular microscope in
Stockholm, solidifying his place in history as the
f
rst true
microsurgeon.
8
In 1946, the American ophthalmologist
Richard Perritt borrowed a binocular operative micro-
scope from his otorhinolaryngologist colleague, G. E.
Shambaugh, for use during an eye operation. Subse-
quently, other specialties, including neurosurgery and
plastic surgery adopted microsurgical techniques during
the 1960s.
5
MICROSURGERY AND UROLOGY
In May 1974, Sherman Silber, an American urologist,
met Earl Owen, a plastic surgeon from Melbourne,
Australia, at a Royal College of Surgeons conference in
Sydney.
9
Owen was a world renowned microsurgeon
having founded the International Microsurgical Society
in 1969,
10
and by most accounts had performed the
f
rst
vasovasostomy in Australia in 1971.
10
At the time of
meeting Silber, Owen was working in organ trans-
plantation. A pioneer in his own right, Silber had devised
a microsurgical method in 1973 to facilitate his studies
with rat kidney transplantation using eyeglasses with
Â
2
magni
f
cation, mosquito forceps
f
led to 1 mm thickness,
and 9-0 suture.
11
Initially interested in transplantation,
Silber
’
s meeting and subsequent partnership with Owen
Financial Disclosure:
The authors declare that they have no relevant
f
nancial interests.
Funding Support:
Alexander W. Pastuszak is a NIH Men
’
s Reproductive Health
Research (MRHR) K12 scholar (HD073917), and a Urology Care Foundation Russell
Scott, Jr., MD, Resident Research Award recipient.
Alexander W. Pastuszak and Evan P. Wenker contributed equally to the preparation
of this article.
From the Center for Reproductive Medicine, Baylor College of Medicine, Houston,
TX; the Scott Department of Urology, Baylor College of Medicine, Houston, TX; and
the Baylor College of Medicine, Houston, TX
Address correspondence to: Larry I. Lipshultz, M.D., Scott Department of Urology,
Lester and Sue Smith Chair in Reproductive Medicine, Baylor College of Medicine,
6624 Fannin St, Suite 1700, Houston, TX 77030. E-mail:
larryl@bcm.edu
Submitted: October 8, 2014, accepted (with revisions): December 5, 2014
ª
2015 Elsevier Inc.
All Rights Reserved
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