Cutting for the Stone

The Celsian Method (or Apparatus Minor)

This ancient technique was described by the Hindus, Greeks and Arabs. The stone is forced against the perineum by a finger in the rectum. An incision is made just to the left of the median raphe onto the bulge of the stone. The stone is pushed and pulled with a finger or hook out of the bladder.

The Marian Method (or Apparatus Major)

This technique was invented in 1520 by John de Romani (also known as Francisco Romano) and described by his pupil, Mariano Santo de Barletta. The bladder was accessed in the midline through the prostatic urethra which was forcibly dilated by instruments allowing the stone to be pulled out.

The Lateral Method

This method was made famous by Frère Jacques in the 17th century and clarified by William Cheselden. A grooved sound was passed into the bladder. A lateral perineal incision was made and deepened onto the grooved staff, cutting through the lateral lobe of the prostate to access the stone

The High Approach

First carried out by Pierre Franco (1500 - 1561), revisited by the Douglas brothers and then by William Cheselden in the 18th century, it fell out of favour until the late 19th century. This suprapubic approach however, would be the most familiar to us today.