Opening the bladder via the perineum in order to remove a bladder stone was practised by the ancient Greek surgeons in very early times, probably from the days of Homer. The technique of lithotomy was described for the first time by Celsus in the first century AD and has come to be known as the lesser operation or ‘apparatus parvus’, so called because only two instruments are needed for it, a knife and a hook. Two fingers of the surgeon’s left hand were introduced into the patient’s rectum while an assistant pressed on the lower abdomen to encourage descent of the stone near the neck of the bladder. A slightly curved incision was made in the skin near the anus and a second transverse incision was made through or immediately above the prostate, opening the bladder neck. The calculus was extracted from the wound by the fingers or by a hook. This ancient method of lithotomy as described by Celsus was the only one performed until the middle of the 16th century, and many surgeons advised the apparatus parvus as the operation of choice in young patients until the middle of the 18th century.

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