Without the Knife

Watch, shot by shot

1. 57:42 Watch from here: Title card
2. 57:48 Watch from here: Some revolutions are small. Around 1930 an American urologist, Frederic Foley, designed a soft…
3. 58:32 Watch from here: On the twenty-third of December, 1954, in Boston, Richard Herrick was dying of kidney failure. His…
4. 59:27 Watch from here: And the stone? It met its strangest enemy of all. Engineers at the German aircraft firm Dornier were…
5. 1:00:02 Watch from here: Now, here is the beautiful part. Take an ellipse. A wave that starts at one focus, and reflects from…
6. 1:00:54 Watch from here: In the same years, surgeons were learning to reach stones through a small puncture in the back, or…
7. 1:01:14 Watch from here: The abdomen, too, was opened less and less. In 1990, in St Louis, Ralph Clayman removed the whole…

What the film says, and the evidence

Verified claims are shown plain. probable means one reliable source; disputed means the sources disagree, and both versions are shown. Unverified material is not published here.

1. Frederic Foley, an American urologist, devised a self-retaining balloon catheter: first described in 1929 to control bleeding after prostatectomy, demonstrated in 1935 and published in 1937 as a one-piece latex 'hemostatic bag catheter'.

   Sources

   1. Wikipedia: Frederic Foley Secondary
   2. Wikipedia: Foley catheter Secondary
   3. F. E. B. Foley, A hemostatic bag catheter: one piece latex rubber structure for control of bleeding and constant drainage following prostatic resection, Journal of Urology 1937; 38:134-139 (title and citation as given on Wikipedia) Primary

   The film's 'around 1930' covers the 1929 description. Wikipedia's catheter article places Foley in Boston in the 1930s; its biography of Foley names him later chief of urology at Ancker Hospital, St Paul.

   Watch 57:49 in the film

2. Paul Raiche of the Davol Rubber Company received a patent on the balloon catheter in 1936. Foley, who applied that October, won before the Patent Office Board of Appeals, but a court reversed the decision and the patent stayed with Raiche. probable

   Sources

   1. Wikipedia: Frederic Foley Secondary

   One detailed source. The screenplay note attributes it to Wikipedia citing Mattelaer and Billiet.

   Watch 57:49 in the film

3. C. R. Bard distributed the devices as 'Foley catheters' from 1935. probable

   Sources

   1. Wikipedia: Frederic Foley Secondary

   The film's 'the name on the catheter stayed Foley's' is the dossier's reading of this fact.

   Watch 57:49 in the film

4. On 23 December 1954, at the Peter Bent Brigham Hospital in Boston, a kidney from Ronald Herrick was transplanted into his identical twin, Richard.

   Sources

   1. Wikipedia: Joseph Murray Secondary
   2. Wikipedia: Kidney transplantation Secondary
   3. Murray, Nobel lecture, 8 December 1990 Primary

   The film's 'dying of kidney failure' is not recorded from these sources (see gaps).

   Watch 58:33 in the film

5. Skin grafted from each twin to the other established that they were genetically identical.

   Sources

   1. Murray, Nobel lecture, 8 December 1990 Primary

   A popular retelling has the twins fingerprinted at a police station; that story is not in Murray's lecture (see myths).

   Watch 58:33 in the film

6. The urologist J. Hartwell Harrison removed the donor kidney and Joseph Murray transplanted it; John Merrill led the nephrology team.

   Sources

   1. Murray, Nobel lecture, 8 December 1990 Primary
   2. Wikipedia: John Hartwell Harrison Secondary

   Watch 58:33 in the film

7. The kidney worked at once, and Richard lived eight more years.

   Sources

   1. Wikipedia: Joseph Murray Secondary
   2. Murray, Nobel lecture, 8 December 1990 Primary

   He married and had two children. The operation took about five and a half hours (probable). The film's further claim, that this was the first organ graft to last years rather than weeks, is not stated in the kit (see gaps).

   Watch 58:33 in the film

8. Murray described it as the first time in medical history that a healthy person underwent major surgery not for his own benefit; before going ahead, the team consulted physicians and clergy.

   Sources

   1. Murray, Nobel lecture, 8 December 1990 Primary

   Asked whether the hospital would guarantee Ronald lifelong care, Harrison said 'Of course not', then asked Ronald whether he thought anyone in the room would ever refuse to take care of him.

   Watch 58:33 in the film

9. Murray shared the 1990 Nobel Prize in Physiology or Medicine with E. Donnall Thomas, for work on organ and cell transplantation.

   Sources

   1. Wikipedia: Joseph Murray Secondary
   2. Murray, Nobel lecture, 8 December 1990 Primary

   Watch 58:33 in the film

10. The aircraft firm Dornier studied the pitting of aircraft skins near the speed of sound, caused by shock waves formed in front of raindrops, as part of research on how shock waves act on solid bodies.

    Sources

    1. Chaussy, Eisenberger and Forssmann 2007, Extracorporeal shockwave lithotripsy (ESWL): a chronology (J Endourol 21:1249-1253) Primary
    2. Dornier: company history Secondary

    Chaussy et al. (2007) also mention micrometeorites. The research was funded by the German Ministry of Defence (probable).

    Watch 59:28 in the film

11. A Dornier engineer in contact with the shock-wave apparatus felt something like an electric shock.

    Sources

    1. Chaussy, Eisenberger and Forssmann 2007, Extracorporeal shockwave lithotripsy (ESWL): a chronology (J Endourol 21:1249-1253) Primary
    2. Xu and Xu, history of shock wave lithotripsy (Atlantis Press) Secondary
    3. Malinaric et al., International Journal of Environmental Research and Public Health 2023; 20(5):4127 Secondary

    The event is verified. Chaussy et al. (2007) describe 'pain as from an electrical shock'; Xu and Xu say the engineer touched the steel target and 'the contact area was not hurt', the only source for the film's 'his skin was unharmed'. Two secondary sources date the event to 1966; the pioneers' own 2007 chronology gives no year, and the film gives none.

    Watch 59:28 in the film

12. The lithotripter produced shock waves with an underwater spark and focused them on the stone through a semi-ellipsoid: the spark lay at one focus and the stone at the other, and water carried the wave into the body. Two X-ray systems in two planes located the stone. probable

    Sources

    1. Chaussy, Eisenberger and Forssmann 2007, Extracorporeal shockwave lithotripsy (ESWL): a chronology (J Endourol 21:1249-1253) Primary

    From the first-hand chronology by the Munich pioneers, the only source; the dossier grades items that rest on it alone probable.

    Watch 1:00:03 in the film

13. Before treating people, the Munich group implanted freshly removed human kidney stones into the dilated collecting systems of dogs. probable

    Sources

    1. Chaussy, Eisenberger and Forssmann 2007, Extracorporeal shockwave lithotripsy (ESWL): a chronology (J Endourol 21:1249-1253) Primary

    At Brendel's Institute of Surgical Research; one first-hand source.

    Watch 1:00:03 in the film

14. The first patient was treated on 7 February 1980 in the Department of Urology of the Munich University Hospital, on the Grosshadern campus.

    Sources

    1. Chaussy, Eisenberger and Forssmann 2007, Extracorporeal shockwave lithotripsy (ESWL): a chronology (J Endourol 21:1249-1253) Primary
    2. Storz Medical: 40 years of ESWL Secondary
    3. Dornier: an important day in medical history Secondary

    The 2007 chronology names Chaussy, Forssmann and Jocham as treating the first patient. First results appeared in The Lancet in December 1980. The film's 'lying in a bath of water' is not recorded from these sources (see gaps); localisation by X-ray is in the previous claim.

    Watch 1:00:03 in the film

15. In the same years stones came to be reached through a puncture in the back: in 1976 Fernström and Johansson described removing kidney stones through a percutaneous nephrostomy under radiological control.

    Sources

    1. BAUS Virtual Museum: Nephroscopy and PCNL Museum or society
    2. S. R. Patel, S. Y. Nakada, The modern history and evolution of percutaneous nephrolithotomy, Journal of Endourology 2014 Secondary

    Earlier steps: Rupel and Brown removed a stone through a surgical nephrostomy track in 1941, and Goodwin described percutaneous nephrostomy in 1955.

    Watch 1:00:55 in the film

16. Purpose-built ureteroscopes followed: in 1980 Pérez-Castro, with Karl Storz, produced the first rigid ureteroscope made for the purpose, used for stone treatment the following year. probable

    Sources

    1. L. A. Whitehurst, B. K. Somani, Urolithiasis 2018 (history of ureteroscopy) Secondary

    12 F and 50 cm long, with a separate optic and working channel. Semi-rigid ureteroscopes followed in 1989.

    Watch 1:00:55 in the film

17. Laser lithotripsy was developed in the 1980s, and holmium:YAG lasers became the standard for breaking stones from the mid-1990s. probable

    Sources

    1. Wikipedia article on laser lithotripsy, as cited in research/03 §16 (URL not recorded in the kit) Secondary

    The first clinical year for holmium is not verified. The film's closing line links these methods to Ammonius, whom Celsus credits with breaking a stone too large to remove whole (see the greece chapter).

    Watch 1:00:55 in the film

18. In 1990 at Washington University, St Louis, Ralph Clayman's team performed the first laparoscopic nephrectomy, on an 85-year-old woman. The 190 g kidney was placed in a sack, broken up and removed through an 11 mm incision.

    Sources

    1. R. V. Clayman et al., Journal of Urology 1991; 146:278-282, and New England Journal of Medicine 1991; 324:1370-1371 (Europe PMC abstract, PMID 1830346) Primary
    2. Wikipedia: Ralph Clayman Secondary

    Published in 1991 in the Journal of Urology and the NEJM. The exact day, often given as 25 June 1990, is not verified.

    Watch 1:01:15 in the film

19. The first laparoscopic radical prostatectomies, nine cases from 1991 to 1995, took a mean of 9.4 hours, and their surgeons concluded that the approach offered no advantage over open surgery.

    Sources

    1. W. W. Schuessler, P. G. Schulam, R. V. Clayman, L. R. Kavoussi, Urology 1997; 50:854-857 (Europe PMC abstract, PMID 9426713) Primary
    2. Wikipedia: Radical prostatectomy Secondary

    Watch 1:01:15 in the film

20. In 2000 Binder and Kramer in Frankfurt performed the first robot-assisted radical prostatectomy, reported in 2001. probable

    Sources

    1. J. Binder, W. Kramer, Robotically-assisted laparoscopic radical prostatectomy, BJU International 2001; 87:408-410 Primary
    2. Wikipedia: Robot-assisted surgery Secondary

    The citation of the 2001 report is verified; the year of the operation, 2000, and its place as the first rest on Wikipedia alone. The month, often given as May 2000, is not verified.

    Watch 1:01:15 in the film

21. Mani Menon built what has been called the first cancer-oriented robotics programme in the world, at the Vattikuti Urology Institute of the Henry Ford Hospital, Detroit. probable

    Sources

    1. Wikipedia article on Mani Menon, as quoted in research/05 §10.1 (URL not recorded in the kit) Secondary

    The programme's start year and the donation behind it are not verified, nor are the film's 'thousands of cases' and its worldwide spread (see gaps).

    Watch 1:01:15 in the film

22. Robotic prostatectomy was adopted rapidly despite a lack of high-quality evidence of better cancer control, safety or cost-effectiveness than open surgery.

    Sources

    1. W. T. Lowrance et al. 2010, abstract read on Europe PMC (PMID 21103791) Primary

    The film's further statements, that head-to-head trials show no gain in cure or function but much less bleeding, cite a 2016 trial that is named only in the screenplay note and credits (see gaps).

    Watch 1:02:20 in the film

23. In 2018 the US FDA cleared a single-port robotic system for urological procedures suited to a single-port approach.

    Sources

    1. FDA 510(k) K173906: da Vinci SP (2018) Primary

    The dossier gives the clearance date as 26 April 2018; the screenplay note gives 31 May 2018 (see conflicts).

    Watch 1:02:20 in the film

Myths corrected

• False. Frederic Foley patented the catheter that bears his name.

  The evidence · Watch 57:49 in the film

• Unsupported. The Herrick twins were proved identical by fingerprinting at a police station.

  The evidence · Watch 58:33 in the film

• False. Joseph Murray performed the first successful kidney transplant on his own.

  The evidence · Watch 58:33 in the film

• Conflated. Lithotripsy began with a single discovery in 1966, when raindrop damage to a jet revealed that shock waves could break stones.

  The evidence · Watch 59:28 in the film

• False. Eisenberger treated the first patient with shock-wave lithotripsy.

  The evidence · Watch 1:00:03 in the film