History of the BSGE

Development of Gynaecological Endoscopy
Laparoscopy was first performed in Russia, Germany and Scandinavia (1, 2, 3) in the early years of the 20th Century. Over the next 20 years individual reports of successful procedures were published from the USA and many European countries including one by Short (4) from England in 1925. The first report of laparoscopy in gynaecology was by Hope from the USA who described its use in the diagnosis of an extrauterine pregnancy in 1937. The first tubal fulguration was performed by Power and Barnes (5) in 1941 although it had been suggested by others several years previously.
 
Raoul Palmer
Laparoscopy was abandoned in the USA in 1939 and replaced by culdoscopy until it was reintroduced in the 1960s. Elsewhere diagnostic laparoscopy was used increasingly as an alternative to exploratory laparotomy. There were constraints in the development of laparoscopy during the Second World War due to difficulties with language and communication as well as deficiencies in the light sources and in the lenses. The problems with lighting (6) were overcome by Fourestiere, Gladu and Voulmiere from Paris who invented cold light illumination in 1943 and in lenses by Hopkins (7), Professor of Physics in Reading University, who replaced the old elliptical lenses with the rod lens in 1953. These two inventions improved the intensity of light and the clarity of vision which made the procedure much safer. The credit for the development of modern laparoscopy should be given to Dr. Raoul Palmer (8).
 
He worked in his private clinic in Paris during the German occupation assisted by his wife, Dr Elizabeth Palmer, and presented his early experiences to the French Society of Obstetrics and Gynaecology in 1947. Hans Frangenheim (9) from Konstanz and Patrick Steptoe (10) from Oldham learnt how to perform laparoscopy from Palmer and introduced the procedure to Germany and England respectively.
 
Hans Frangenheim Patrick Steptoe
Kurt Semm

Maurice Bruhat
 James Daniell
 
Kurt Semm (11) from Kiel performed operative laparoscopy against strong opposition in his own country using thermocoagulation to control bleeding while others used mono- and bi-polar electrocoagulation.  Finally laser was first introduced by Yona Tadir in Israel (12) followed by Maurice Bruhat (13) in Clermont-Ferrand, Chris Sutton (14) in Guildford and James Daniell (15) in Nashville.
 
Hans Lindemann Jacques Hamou
 
Hysteroscopy was also used from the early years of the 20th Century but problems with distension media and endometrial bleeding made it difficult to perform.  Hans Lindemann (16) from Hamburg demonstrated the safety of CO2 in 1973 and Jacques Hamou (17) from Paris developed an advanced magnifying lens system in 1980.  As in the case of laparoscopy, hysteroscopy was for many years solely a diagnostic procedure until 1976 when Robert Neuwirth (18) from New York used it to remove submucous fibroids and Alan DeCherney (19) from Yale used a resectoscope loop to treat intractable bleeding in 1983.  Again as in laparoscopy, laser was adapted to replace monopolar electrocoagulation by Milton Goldrath (20) from Detroit in 1981.

Gynaecological endoscopy in UK
There was little enthusiasm in Britain for either laparoscopy or hysteroscopy in the early years of their development.  Diagnostic laparoscopy and tubal electrocoagulation or clipping were widely practiced and a few gynaecologists such as Victor Lewis of Watford and Joe Davis of Glasgow performed diagnostic hysteroscopy but, in general, the   uptake was slow and nobody had attempted operative hysteroscopy until the late 1980s.
 
Alan Gordon
Alan Gordon from Hull visited Kurt Semm   in 1977 and started using his techniques to perform minor and intermediate surgery.  The instrument companies were unhappy about the lack of interest in the UK and in 1987 Karl Storz approached Gordon and asked him to organise a symposium with live surgery to demonstrate the possibilities of operative endoscopy.  He spoke with Sir Alec Turnbull (21), Professor of Obstetrics and Gynaecology in Oxford and asked if he could run a symposium in his unit.  He went to Oxford and performed several endoscopic procedures to demonstrate the range of operations available at that time. Sir Alec saw the potential of endoscopic surgery and was immediately supportive and offered the full use of his hospital’s facilities.  A series of three annual symposia were organised to audiences of from 50 to nearly 500 participants, many of whom were seeing this type of surgery for the first time.

The symposia were under the titular chairmanship of Sir Alec Turnbull, Alan Gordon organised the programme and invited the surgeons and Adam Magos who was Lecturer/Senior Registrar at the time, was the local organiser.  Mrs Storz allowed up to four overseas surgeons.  Ivo Brosens (Leuven), Bruno van Herendael (Antwerp) and Jacques Hamou attended all the meetings.  Hubert Manhes (Vichy) and Alain Audebert (Bordeaux) each attended once.  British surgeons were also involved with Alan Gordon, Chris Sutton and Adam Magos operating alongside the European surgeons.  The support given by Sir Alec both before and during these meetings cannot be over-emphasised.  He allowed the organisers full use of all the facilities of his department and, although he was terminally ill, he attended every session as well as acting as host at the evening dinners.  This was typical of his generosity and enthusiasm and of his encouragement of the development of new ideas.

As a direct result of this exposure to new techniques, many gynaecologists started to perform endoscopic surgery, especially endometrial resection.  They had seen them being performed by experts who made them look easy and decided to do it themselves without supervision or training.  Inevitably there were complications and there were at least six deaths from endometrial ablation.  There was no support in providing training either from the Royal College (RCOG), the GMC or the Department of Health who are responsible for training, maintenance of standards and funding respectively.  Indeed at a meeting in 1992 between representatives of the new British Society for Gynaecological Endoscopy (BSGE), the RCOG, who were now supportive, and the Department of Health to request funding for a simple inquiry into the complication rate of endoscopic surgery, the only funds offered were to finance a national double-blind trial of endometrial resection versus hysterectomy. Clearly this was impracticable.
 
Societies for Gynaecological Endoscopy
During the 1980s and 1990s a number of Societies for Gynaecological Endoscopy were established.  The leading nations in the development of endoscopy each had their own Societies.  The oldest of these is the Societe Medicale Internationale Endoscopique et Radio-Camera followed by the Deutsche Gesekschaft fur Endoskopie in France and Germany.  
 
Jordan Phillips
The largest is the American Association of Gynecologic Laparoscopists (AAGL) which was led for many years by Jordan Phillips.  He formed teaching teams which ran refresher courses, studied complications and introduced endoscopy to many countries.  He was also responsible for the organisation of many successful congresses throughout the world.

There was no similar European Society and the International Society (ISGE) was not formed until 1989.  The European Society of Hysteroscopy (ESH) was formed in the 1970s by a group led by Hans Lindemann but it never received support from the European laparoscopists until after the formation of the ESGE in 1992.  The two Societies  eventually merged in 1995.
 
British Society for Gynaecological Endoscopy
In 1999 Adam Magos suggested to Alan Gordon that a British Society be formed to encourage the development of these new techniques, provide facilities for training and monitor and prevent complications.  In November 1989 an informal meeting was held in the President’s House at the College between Alan Gordon, Victor Lewis, Chris Sutton and Adam Magos. They decided to form a British Society and an exploratory meeting was held in Guildford in February 1990.  About 30 people were invited and they agreed to form a new British Society for Gynaecological Endoscopy (BSGE) with the Officers coming from the four founders. Alan Gordon was the first President; Victor Lewis was Vice-President; Chris Sutton Secretary and Adam Magos was the Treasurer.

The first full meeting of the new BSGE was held in Hull in September 1990 when Jacques Donnez from Brussels was the key-note speaker.  It took the form of a two day presentation of scientific papers with a dinner in the hotel on the first evening.  The meeting was very successful with about 50 participants, many of whom have since become leaders in the field.  It was decided at that meeting to name the key-note speech the “Alec Turnbull Memorial Lecture” to honour Sir Alec and recognise the great support he gave in Oxford where endoscopic surgery was introduced to a wide audience for the first time in UK and the foundations of the Society were laid.

References
  1. von Ott D (1901) Ventroscopic illumination of the abdominal cavity in pregnancy.  Zhurnal Akrestierstova I Zhenskikh Boloznei 15:7-8
  2. Kelling G (1902) Uber Oesophagoskopie, Gastroskopie und Koelioskopie. Munchner Medizinische Wochenschrift.  49(1): 22-24
  3. Jacobaeus HC (1910) Uber due Moglichkiel die Cystoskopie bei Untersuchlung seroser Hohlungen anzerwerden.  Munchner Medizinische Wochenschrift 57: 2090-2092
  4.  Short R (1925) The uses of coelioscopy.  British Medical Journal, 8, 254
  5. Power HH, Barnes AC (1941) Sterilization by means of peritoneosopic fulgaration: a preliminary report. American Journal of Obstetrics and Gynecology 41:1038-1043
  6. Fourestiere M, Gladu A, Vulmiere J (1943) La peritoneoscopie.  Presse Medicale 5: 46-47
  7. Hopkins HH (1953) On the diffraction theory of optical images.  Proceedings of the Royal Society A217: 408
  8. Palmer R (1948) La coelioscopie. Bruxelles Medicale 28:305-312
  9. Frangenheim H (1959)  Die Laparoskopie und die Culdoscopy im der Gynaecologie.  Stuttgart :Georg Thieme
  10. 1Steptoe PC (1967) Laparoscopy in Gynaecology. Edinburgh, E&S Livingstone, Picture from Royal College of Obstetricians and Gynaecologists
  11. Semm K (1970) Weitere entwicklungen in der gynakologischen Laparoskopie-Gynakologisch Pelviskopie.  In Klinik der Frauenheilkulde und Geburtshilfe (Vol 1).   Edited by Schwalm H, Doderlein G. Pp326-339. Munchen: Urban & Schwarzenberg.
  12. 1Tadir Y, Ovadia J, Zukerman Z et al (1981) Laparoscopic application of CO2 laser.  In Atsumi K, Nimsakul N (eds) Laser Tokyo 81. Pp 13-27. Tokyo: Inter Group Corp.
  13. Bruhat M, Mage G, Manhes H (1979) Use of CO2 laser via laparoscopy.  In Kaplan I (ed.) Laser surgery III, Proceedings of the Third International Society for Laser Surgery, pp 274-276, Tel Aviv: Ot-Paz.
  14. Sutton CJG (1985) Initial experience with carbon dioxide laser laparoscopy.  Lasers: Medical Science1: 25-31
  15. Daniell JF, Brown DH (1982) Carbon dioxide laser laparoscopy: initial experience in experimental animals and humans.  Obstetrics and Gynecology 59: 761-764
  16. Lindemann H (1973) Historical aspects of hysteroscopy.  Fertility and Sterility 24:230-243
  17. Hamou JE (1980) Hysteroscopie et microhysteroscopie avec un  instrumant nouveau : le microhysteroscope.  Acta Endoscope 10 : 415
  18. Neuwirth RS, Amin JH (1976) Excision of submucous fibroids with hysteroscopic control. American Journal of Obstetrics and Gynecology 126:95-99
  19. DeCherney AH. Polan ML (1983) Hysteroscopic management of intra-uterine lesions and intractable uterine bleeding.  Obstetrics and Gynecology 61: 392-397
  20. Goldrath MH, Fuller TA, Segal S (1981) Laser photovaporization of endometrium for the treatment  of menorrhagia.  American Journal of Obstetrics and Gynecology.140(1): 14-19
  21. Turnbull A, Picture from Royal College of Obstetricians and Gynaecologists