Cholecystectomy by “mini-laparotomy” under local anesthesia represented a trend toward reducing the surgical incision. This technique was developed in the early 1970s and became popular in France.10
The small incision and absence of drainage catheters led to a very short postoperative hospitalizaron; in many cases, a so-called “one-day cholecystectomy” was possible.11
By the early 1990s, surgeons at the Hospital International of the University of Paris had performed more than 1,500 such operations.12
One of those surgeons, Francois Dubois, advocated the “mini-cholecystectomy,” convinced it offered the best possible surgical access to gallbladder disorders. He was particularly proud of its patient-centered aspect.
As Dubois remembers it, in the fall of 1987 he was closing an operative incision when he noticed a new nurse on the operating team.13
He called her attention to “the smallest scar in the world after gallbladder removal.”14
But Claire Jeaupitre remained unimpressed. “There is another way of removing the gallbladder by an even smaller opening,” she responded.15
Dubois was astounded. She continued, “I mean the laparoscopic cholecystectomy.” “Removing a gallstone by means of a laparoscope is not possible,” returned Dubois. Jeaupitre explained that a surgeon in Lyon named Mouret was using a laparoscope to remove gallbladders. Dubois could only repeat (a bit angrily), “Laparoscopic cholecystectomy is not possible!” But the nurse held her ground and suggested that he call Mouret, with whom she had worked before moving to Paris.16
Mouret had never met Dubois before and was surprised by his call. The Paris surgeon stated he would be interested in obtaining more information about Mouret's experiments with laparoscopic surgery. Mouret pointed out that laparoscopic removal of the gallbladder was not in the experimental, but rather in the clinical, stage. He offered to show Dubois a video tape of the technique. Since he happened to be coming to Paris for a gynecological meeting, the two surgeons agreed to meet there in a couple of weeks.17
It was December 198718
(or January 1988)19
when Dubois and Mouret met in the Paris Hilton, a stone's throw from the Eiffel Tower. Mouret recalls that Dubois said little, his attention concentrated on the video with an occasional “hm, hm” tossed in. “Dubois then said ‘thank you very much, very interesting, good bye.’ That was all,” noted Mouret seven years later.20
Dubois had watched a tape of two cases. Perhaps he was reserved in his reaction that evening, but Mouret's demonstration impressed him. The tape of a step-by-step laparoscopic cholecystectomy (LC) convinced Dubois that endoscopie removal of the gallbladder was possible.
Dubois was an open-minded surgeon. Along with his work on “mini-laparotomy” cholecystectomy, he decided to devote some of his energy to Mouret's method. Dubois acted immediately, collecting literature on laparoscopic surgery. “I had no prior laparoscopic experience,” he recalled in 1995 (
). “Especially the books of Semm drew my attention.”21
He borrowed laparoscopic instruments from gynecologists. Interestingly, Dubois used a monocular endoscope of 10 mm with a cold-light optic; the video camera had to be attached to the eye piece outside the patient's body.22
Dubois soon accumulated his first experiences with basic laparoscopic technique on animals and moved on to clinical tests. He describes these first cases:
At the very beginning I was not skilled enough to finish this procedure in the endoscopie way. The first operations I always began laparoscopically, but I finished the procedure using laparotomy. Finally it worked! My first fully laparoscopic cholecystectomy was done at the end of April 1988.23
“I had no prior experience with laparoscopy.” Francois Dubois of Paris (1995). Fig. 16-4 in Highlights.