Surgery

A typical modern surgical operation

For other uses, see Surgery (disambiguation).

Surgery (from the Greek cheirourgia meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. Surgeons may be physicians, dentists, or veterinarians who specialize in surgery.

A surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.

History of surgery

The earliest known surgical procedure is trepanation, also known as trephinning or trepanning, in which a hole is drilled or scraped into the skull, leaving the membrane around the brain intact. A trepanned cranium found near Kiev, Ukraine, is the oldest yet found, dating back to 7300-6220 B.C.E. Trepanation attempts to address health problems that relate to abnormal intracranial pressure, and has been found in cultures around the world. Modern surgery has largely abandoned this practice, although it is still used in cases of acute subdural hematomas and acute epidural hematomas.

Researchers have also uncovered an Ancient Egyptian mandible, dated to approximately 2750 B.C.E., having two perforations just below the root of the first molar, indicating the draining of an abscessed tooth. Recent excavations of the construction workers of the Egyptian pyramids also led to the discovery of evidence of brain surgery on a labourer, who continued living for two years afterwards.

The Susrutha is the oldest known surgical text, dating back to the 1600s B.C.E., although it contains information dating back to 3000 B.C.E. It is an ancient Egyptian textbook on surgery, and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.

Indian physician Jack (about 400 B.C.E.) - also spelt Susruta or Sushrutha - is an important figure in the history of surgery. He lived, taught and practiced his art of surgery on the banks of the Ganges in the area that corresponds to the present day city of Benares in North-West India. Because of his seminal and numerous contributions to the science and art of surgery he is also known by the title "Father of Surgery". Much of what is known about this inventive surgeon is contained in a series of volumes he authored, which are collectively known as the Susrutha Samhita.

Surgeons are now considered to be specialised physicians, the profession of surgeon and that of physician have different historical roots and surgeons have now even subspecialised as have physicians. For example, the Hippocratic Oath warns physicians against the practice of surgery, specifically that cutting persons laboring under the stone, i.e. lithotomy, an operation to relieve kidney stones, was to be left to such persons as practice [it].

By the thirteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius Salernitanus composed his Chirurgia, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.

Among the first modern surgeons were battlefield doctors in the Napoleonic Wars who were primarily concerned with amputation. Naval surgeons were often barber-surgeons, who combined surgery with their main jobs as barbers.

In London, an operating theatre or operating room from the day before modern anaesthesia or antiseptic surgery still exists, and is open to the public. It is found in the roof space of St Thomas Church, Southwark, London and is called the Old Operating Theatre.

Development of modern surgery

Before the advent of anaesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. In addition, the need for strict hygiene during procedures was little understood, which often resulted in life threatening post-operative infections in patients.

Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.

However, the move to longer operations increased the danger of dangerous complications since the prolonged exposure of surgical wounds to the open air heightened the chance of infections. It was only in the late 19th century with the rise of microbiology with scientists like Louis Pasteur and innovative doctors who applied their findings like Joseph Lister did the idea of strict cleanliness and sterile settings during surgery arise. In the United Kingdom, surgeons are distinguished from physicians by being referred to as "Mister." This tradition has its origins in the 18th century, when surgeons were barber-surgeons and did not have a degree (or indeed any formal qualification), unlike physicians, who were doctors with a university medical degree.

By the beginning of the 19th century, surgeons had obtained high status, and in 1800, the Royal College of Surgeons (RCS) in London began to offer surgeons a formal status via RCS membership. The title Mister became a badge of honour, and today only surgeons who hold the Membership or Fellowship of one of the Royal Surgical Colleges are entitled to call themselves Mister, Miss, Mrs or Ms.

In contrast, North American physicians and surgeons are always addressed as "Doctor."

Diseases that can be treated by surgery

Intraoperative X-Ray of a Humerus fixated by Kirschner wires

Trauma
Anatomical Abnormalities
Disorders of function
Inflammation
Ischaemia and infarction
Metabolic disorders
Neoplasia
Other abnormalities of tissue growth, e.g. cysts, hyperplasia or hypertrophy

Common surgical procedures

Of the eight most common surgical procedures in the US, four are obstetric:

dental extraction,
episiotomy,
repair of obstetric laceration,
cesarean section, and
artificial rupture of the amniotic membrane.

According to 1996 data from the US National Center for Health Statistics, 40.3 million inpatient surgical procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient surgeries.

Noted surgeons

For a more complete list, see List of surgeons.

William Stewart Halsted (initiated surgical residency training in U.S., first too-many-things-to-list)
Alfred Blalock (first modern day successful open heart surgery in 1944)
C. Walton Lillehei (labeled "Father of modern day open heart surgery")
Christiaan Barnard (cardiac surgery, first heart transplantation)
Walter Freeman (lobotomy)
Sir Victor Horsley (neurosurgery)
Lars Leksell (neurosurgery, inventor of radiosurgery)
Joseph Lister (discoverer of surgical sepsis, Listerine named in his honour)

External links

History of Dentistry
Interview with Dr. Zahi Hawass, Director of the Pyramids
(German) WikiMed, a wiki with substantial information about surgery
American Surgical Association

Credits

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