Why is it called the lithotomy position?

The lithotomy position is well known to medical students, especially in Obs and Gyn. It is characterized by the patient lying supine (on her back) with hips and knees flexed and thighs separated as shown above. This position is ideal for vaginal examinations and is the usual position for childbirth.

But where does it get its name? Is it like many other medical terms eponymously derived from the name of a famous doctor in history? Actually no (although there was an ancient surgeon who was named after it- we’ll come to this later). It comes from the Greek word lithos meaning stone (+ tomos=cut). But what does this have to do with the position? Actually, this is the position used in ancient times for surgical procedures to remove stones (kidney stones, bladder stones, gallstones) via the perineum.

In those days, the lithotomy operation was done without anaesthesia and was intensely painful! Death rates were very high, so much so that the Hippocratic oath stipulated that “I will not cut for stone, even for the patients in whom the disease is manifest; I will leave this operation to be performed by practitioners.” The “practitioners” referred to were surgeons (who were different to physicians at that time). At that time a few specialists practiced perineal lithotomy, notably Ammonius Lithotomos of the 3rd century B.C.E. The muslim surgeon Alzahrawi (Albucasis) (1000 C.E.) improved the procedure with a new technique using a special instrument he invented, thereby reducing death rates. It is described in great detail here: http://rabieabdelhalim.com/zahrawiBladderStoneExtraction.pdf An interesting read for budding urologists!