Surgery

A cardiothoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center, November 1990.

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

Researchers have uncovered an Ancient Egyptian mandible, dated to approximately 2750 BC, with 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.

Indian physician Sushruta (600 BC) 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. It is the oldest known surgical text and it describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.

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, Greek tradition was against opening the body and 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]. Of course, most knowledge of surgery comes from dissecting bodies, a science which was repulsive to many healers.

By the thirteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Montpellier, Padua and Bologna Universities were particularly interested in the academic side to Surgery, and by the fifteenth century at the latest, Surgery was a separate university subject to Physic. 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.

Surgery recently came under the domain of unmanned robots [1].

Development of modern surgery

Before the advent of anesthesia, 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 or not as the case may be. 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, Australia and New Zealand 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:
** episiotomy,
** repair of obstetric laceration,
** cesarean section, and
** artificial rupture of the amniotic membrane.
*The most common non-obstetric surgeries include:
** dental extraction
** circumcision

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

* Blog containing images from various surgical procedures
* A Manual of Military Surgery, by Samuel D. Gross, MD (1861). The manual used by doctors in the Union Army during the American Civil War.
* A Manual of Military Surgery (1863). The manual used by doctors in the Confederate States Army during the American Civil War.
* History of Dentistry
* An On-Line Surgery Journal Club (via JournalReview.org)
* Interview with Dr. Zahi Hawass, Director of the Pyramids
* American Surgical Association
* Overview of different Surgical Procedures
*The Journey, by surgeon E. T. Rulison, Jr., M.D., F.A.C.S., first-hand account and photographs of the 51st Evacuation Hospital during World War II
*The Nurses of the 51st Evac Hospital In WWII, by nurse First Lieutenant Tillie (Horath) Kehrer, first-hand account and photographs of the 51st Evacuation Hospital during World War II
*Unmanned robot surgeon

Surgery: Encyclopedia BETA

Contents