History of Surgical Stapling (3)

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A Moment in History

Jean George Bachmann
(1877 – 1959)

French physician–physiologist whose experimental work in the early twentieth century provided the first clear functional description of a preferential interatrial conduction pathway. This structure, eponymically named “Bachmann’s bundle”, plays a central role in normal atrial activation and in the pathophysiology of interatrial block and atrial arrhythmias.

As a young man, Bachmann served as a merchant sailor, crossing the Atlantic multiple times. He emigrated to the United States in 1902 and earned his medical degree at the top of his class from Jefferson Medical College in Philadelphia in 1907. He stayed at this Medical College as a demonstrator and physiologist. In 1910, he joined Emory University in Atlanta. Between 1917 -1918 he served as a medical officer in the US Army. He retired from Emory in 1947 and continued his private medical practice until his death in 1959.

On the personal side, Bachmann was a man of many talents: a polyglot, he was fluent in German, French, Spanish and English. He was a chef in his own right and occasionally worked as a chef in international hotels. In fact, he paid his tuition at Jefferson Medical College, working both as a chef and as a language tutor.

The intrinsic cardiac conduction system was a major focus of cardiovascular research in the late nineteenth and early twentieth centuries. The atrioventricular (AV) node was discovered and described by Sunao Tawara and Karl Albert Aschoff in 1906, and the sinoatrial node by Arthur Keith and Martin Flack in 1907.

While the connections that distribute the electrical impulse from the AV node to the ventricles were known through the works of Wilhelm His Jr, in 1893 and Jan Evangelista Purkinje in 1839, the mechanism by which electrical impulses spread between the atria remained uncertain.

In 1916 Bachmann published a paper titled “The Inter-Auricular Time Interval” in the American Journal of Physiology. Bachmann measured activation times between the right and left atria and demonstrated that interruption of a distinct anterior interatrial muscular band resulted in delayed left atrial activation. He concluded that this band constituted the principal route for rapid interatrial conduction.

Subsequent anatomical and electrophysiological studies confirmed the importance of the structure described by Bachmann, which came to bear his name. Bachmann’s bundle is now recognized as a key determinant of atrial activation patterns, and its dysfunction is associated with interatrial block, atrial fibrillation, and abnormal P-wave morphology. His work remains foundational in both basic cardiac anatomy and clinical electrophysiology.

Sources and references
1. Bachmann G. “The inter-auricular time interval”. Am J Physiol. 1916;41:309–320.
2. Hurst JW. “Profiles in Cardiology: Jean George Bachmann (1877–1959)”. Clin Cardiol. 1987;10:185–187.
3. Lemery R, Guiraudon G, Veinot JP. “Anatomic description of Bachmann’s bundle and its relation to the atrial septum”. Am J Cardiol. 2003;91:148–152.
4. "Remembering the canonical discoverers of the core components of the mammalian cardiac conduction system: Keith and Flack, Aschoff and Tawara, His, and Purkinje" Icilio Cavero and Henry Holzgrefe Advances in Physiology Education 2022 46:4, 549-579.
5. Knol WG, de Vos CB, Crijns HJGM, et al. “The Bachmann bundle and interatrial conduction” Heart Rhythm. 2019;16:127–133.
6. “Iatrogenic biatrial flutter. The role of the Bachmann’s bundle” Constán E.; García F., Linde, A.. Complejo Hospitalario de Jaén, Jaén. Spain
7. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 172–189, 1907.

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Details: Written by: Efrain A. Miranda, Ph.D.; Published: May 01, 2015; Hits: 14448

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

History of Surgical Stapling
Surgical staplers through history

In the mid 1900’s the Soviet Ministry of Health established in Moscow the Scientific Research Institute for Experimental Surgical Apparatus and Instruments. This was forced by the need to train surgeons to perform complex operations at long distances from the capital cities. The Institute developed an incredible array of instruments including single line, linear cutter, and circular staplers which had applications such as gastrointestinal stapling, bone staplers, skin staplers, cornea and vascular staplers. etc. One of the problems of these instruments was that since they were hand-made, the parts from different staplers were not necessarily interchangeable.

The Moscow Thoracic Surgical Institute had very good results with the bronchial stapler, and it was here that in 1958, almost by chance, Dr. Mark M. Ravitch (1910 – 1989) and three other American physicians had the opportunity to evaluate patients that had been operated with this instrument, as well as seeing it in use.

Again, totally by chance, Dr. Ravitch happened to find a store that carried this instrument and as he tells “…quite unnecessarily I am sure, I identified myself plainly as an American. The only instrument they had in stock that day was the bronchial stapler…” He brought the instrument to the Thoracic Institute where the personnel calibrated it. This instrument came back to the USA with him to start a revolution in surgery.

Back in the USA, Dr. Ravitch started research with this and other instruments he procured in later trips. He recruited Dr. Felicien Steichen (1926 – 2011) to work with him, starting a friendship and collaboration that would last until his death. Both Drs. Ravitch and Steichen helped perfect and develop the modern instruments we use today: The linear stapler, the linear cutter, and the circular stapler.

Once these instruments were introduced, the development and advancement of the technology was pioneered by medical industry in the USA. First with Mr. Leon Hirsch, founder of the U.S. Surgical Corporation (today Covidien Surgical Devices), and later by Johnson and Johnson’s Ethicon Endo-Surgery (today Ethicon). These companies developed first the reloadable reusable surgical staplers and later the disposable reloadable surgical staplers.

Minimally invasive surgery (MIS) was common with gynecologist, but not used by general surgeons. Dr. Erich Muhe (1938 – 2005) was the first to perform a laparoscopic cholecystectomy in 1985, followed by many others. With the advent of MIS, these companies launched the development of laparoscopic surgical staplers, quite common today.

What about the future? First is the development of newer stapling technologies that take into account the viscoelastic behavior of tissues under rapid compression, multiple height staple lines, microstaplers, etc. Then, the advent of NOTES (Natural Orifice Transluminal Endoscopic Surgery) needs the development of smaller and smaller surgical staplers that can be used through a natural orifice and delivered through a flexible endoscope. That is, for now, the new frontier of surgical stapling.

The history of surgical stapling [1] ; [2]; [3]; [Video]

Sources
1. "Surgical stapling" Mallina, R F 1962 Scientific American 207, 48
2. “Science of Stapling: Urban Legend and Fact” Pfiedler & Ethicon EndoSurgery
3. “Cholecystointestinal, gastrointestinal, enterintestinal anastomosis, and approximation without sutures” Murphy JB. Med Rec (1892) 42: 665
4. “Study of Tissue Compression Processes in Suturing Devices” Astafiev, G. (1967 (USSR Ministry of Health, Ed.)
5. “Rese?as Hist?ricas: John Benjamin Murphy” Parquet, R.A. Acta Gastroenterol Latinoam 2010;40:97br />6. “The Science of Stapling and Leaks” Baker, R. S., & et al. (2004) Obesity Surgery, 14, 1290-1298.
7. “John Benjamin Murphy – Pioneer of gastrointestinal anastomosis”Bhattacharya, K., & Bhattacharya, N. (2008). Indian J. Surg., 70, 330-333.
8. “The Story of Surgery” Graham, H. (1939) New York: Doubleday, Doran & Co.. Inc.
9. “Compression Anastomosis: History and Clinical Considerations”Kaidar-Person, O, et al, e. (2008) Am J Surg, 818-826.
10. “Current Practice of Surgical Stapling”Ravitch, M. M., Steichen, F. M., & Welter, R. (1991) Philadelphia: Lea& Febiger.
11. “Aladar Petz (1888-1956) and his world-renowned invention: The gastric stapler” Olah, A. Dig Surg 2002: 19; 393-399
NOTE: The copyright notice for the images in this article can be found in the series "The History of Surgical Stapling" in this website

History of Surgical Stapling (3)

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