Surgery

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This article is about the medical specialty. Surgery_sentence_0

For other uses, see Surgery (disambiguation). Surgery_sentence_1

Surgery is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas. Surgery_sentence_2

The act of performing surgery may be called a surgical procedure, operation, or simply "surgery". Surgery_sentence_3

In this context, the verb "operate" means to perform surgery. Surgery_sentence_4

The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse. Surgery_sentence_5

The person or subject on which the surgery is performed can be a person or an animal. Surgery_sentence_6

A surgeon is a person who practices surgery and a surgeon's assistant is a person who practices surgical assistance. Surgery_sentence_7

A surgical team is made up of the surgeon, the surgeon's assistant, an anaesthetist, a circulating nurse and a surgical technologist. Surgery_sentence_8

Surgery usually spans from minutes to hours, but it is typically not an ongoing or periodic type of treatment. Surgery_sentence_9

The term "surgery" can also refer to the place where surgery is performed, or, in British English, simply the office of a physician, dentist, or veterinarian. Surgery_sentence_10

Definitions Surgery_section_0

Surgery is an invasive technique with the fundamental principle of physical intervention on organs/organ systems/tissues for diagnostic or therapeutic reasons. Surgery_sentence_11

As a general rule, a procedure is considered surgical when it involves cutting of a person's tissues or closure of a previously sustained wound. Surgery_sentence_12

Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment, anesthesia, antiseptic conditions, typical surgical instruments, and suturing or stapling. Surgery_sentence_13

All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being excised (e.g. laser ablation of the cornea) or to a radiosurgical procedure (e.g. irradiation of a tumor). Surgery_sentence_14

Types of surgery Surgery_section_1

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation. Surgery_sentence_15

Surgery_unordered_list_0

  • Based on timing: Elective surgery is done to correct a non-life-threatening condition, and is carried out at the person's request, subject to the surgeon's and the surgical facility's availability. A semi-elective surgery is one that must be done to avoid permanent disability or death, but can be postponed for a short time. Emergency surgery is surgery which must be done without any delay to prevent death or serious disabilties and/or loss of limbs and functions.Surgery_item_0_0
  • Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition. Cosmetic surgery is done to subjectively improve the appearance of an otherwise normal structure.Surgery_item_0_1
  • By type of procedure: Amputation involves cutting off a body part, usually a limb or digit; castration is also an example. Resection is the removal of all of an internal organ or body part, or a key part (lung lobe; liver quadrant) of such an organ or body part that has its own name or code designation. A segmental resection can be of a smaller region of an organ such as a hepatic segment or a bronchopulmonary segment. Excision is the cutting out or removal of only part of an organ, tissue, or other body part from the person. Extirpation is the complete excision or surgical destruction of a body part. Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the person undergoing surgery. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery.Surgery_item_0_2
  • By body part: When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones or muscles).Surgery_item_0_3
  • By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer incisions to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure such as a laparotomy requires a large incision to access the area of interest.Surgery_item_0_4
  • By equipment used: Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments. Microsurgery involves the use of an operating microscope for the surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci or the ZEUS robotic surgical systems, to control the instrumentation under the direction of the surgeon.Surgery_item_0_5

Terminology Surgery_section_2

Main article: List of surgical procedures Surgery_sentence_16

Surgery_unordered_list_1

  • Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy.Surgery_item_1_6
  • Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the abdominal wall to gain access to the abdominal cavity is a laparotomy.Surgery_item_1_7
  • Minimally invasive procedures, involving small incisions through which an endoscope is inserted, end in -oscopy. For example, such surgery in the abdominal cavity is called laparoscopy.Surgery_item_1_8
  • Procedures for formation of a permanent or semi-permanent opening called a stoma in the body end in -ostomy.Surgery_item_1_9
  • Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in -oplasty. Rhino is used as a prefix for "nose", therefore a rhinoplasty is reconstructive or cosmetic surgery for the nose.Surgery_item_1_10
  • Repair of damaged or congenital abnormal structure ends in -rraphy.Surgery_item_1_11
  • Reoperation (return to the operating room) refers to a return to the operating theater after an initial surgery is performed to re-address an aspect of patient care best treated surgically. Reasons for reoperation include persistent bleeding after surgery, development of or persistence of infection.Surgery_item_1_12

Description of surgical procedure Surgery_section_3

Location Surgery_section_4

Inpatient surgery is performed in a hospital, and the person undergoing surgery stays at least one night in the hospital after the surgery. Surgery_sentence_17

Outpatient surgery occurs in a hospital outpatient department or freestanding ambulatory surgery center, and the person who had surgery is discharged the same working day. Surgery_sentence_18

Office surgery occurs in a physician's office, and the person is discharged the same working day. Surgery_sentence_19

At a hospital, modern surgery is often performed in an operating theater using surgical instruments, an operating table, and other equipment. Surgery_sentence_20

Among United States hospitalizations for nonmaternal and nonneonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures. Surgery_sentence_21

The environment and procedures used in surgery are governed by the principles of aseptic technique: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. Surgery_sentence_22

All surgical instruments must be sterilized, and an instrument must be replaced or re-sterilized if, it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). Surgery_sentence_23

Operating room staff must wear sterile attire (scrubs, a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure. Surgery_sentence_24

Preoperative care Surgery_section_5

Main article: Preoperative care Surgery_sentence_25

Prior to surgery, the person is given a medical examination, receives certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system. Surgery_sentence_26

If these results are satisfactory, the person requiring surgery signs a consent form and is given a surgical clearance. Surgery_sentence_27

If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. Surgery_sentence_28

If the surgery involves the digestive system, the person requiring surgery may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before the procedure. Surgery_sentence_29

People preparing for surgery are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the person vomits during or after the procedure. Surgery_sentence_30

Some medical systems have a practice of routinely performing chest x-rays before surgery. Surgery_sentence_31

The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly. Surgery_sentence_32

However, medical specialty professional organizations recommend against routine pre-operative chest x-rays for people who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray. Surgery_sentence_33

Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the person. Surgery_sentence_34

Likewise, other tests including complete blood count, prothrombin time, partial thromboplastin time, basic metabolic panel, and urinalysis should not be done unless the results of these tests can help evaluate surgical risk. Surgery_sentence_35

Staging for surgery Surgery_section_6

Intraoperative phase Surgery_section_7

The intraoperative phase begins when the surgery subject is received in the surgical area (such as the operating theater or surgical department), and lasts until the subject is transferred to a recovery area (such as a post-anesthesia care unit). Surgery_sentence_36

An incision is made to access the surgical site. Surgery_sentence_37

Blood vessels may be clamped or cauterized to prevent bleeding, and retractors may be used to expose the site or keep the incision open. Surgery_sentence_38

The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then the peritoneum. Surgery_sentence_39

In certain cases, bone may be cut to further access the interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage. Surgery_sentence_40

Whilst in surgery aseptic technique is used to prevent infection or further spreading of the disease. Surgery_sentence_41

The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands. Surgery_sentence_42

An antiseptic solution is applied to the area of the person's body that will be operated on. Surgery_sentence_43

Sterile drapes are placed around the operative site. Surgery_sentence_44

Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Surgery_sentence_45

Work to correct the problem in body then proceeds. Surgery_sentence_46

This work may involve: Surgery_sentence_47

Surgery_unordered_list_2

  • excision – cutting out an organ, tumor, or other tissue.Surgery_item_2_13
  • resection – partial removal of an organ or other bodily structure.Surgery_item_2_14
  • reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internal suturing or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis.Surgery_item_2_15
  • reduction – the movement or realignment of a body part to its normal position. e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics.Surgery_item_2_16
  • ligation – tying off blood vessels, ducts, or "tubes".Surgery_item_2_17
  • grafts – may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question. Although grafting is often used in cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area of the person's body and inserted to another area of the body. An example is bypass surgery, where clogged blood vessels are bypassed with a graft from another part of the body. Alternatively, grafts may be from other persons, cadavers, or animals.Surgery_item_2_18
  • insertion of prosthetic parts when needed. Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometimes a plate is inserted to replace a damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or valves may be inserted. Many other types of prostheses are used.Surgery_item_2_19
  • creation of a stoma, a permanent or semi-permanent opening in the bodySurgery_item_2_20
  • in transplant surgery, the donor organ (taken out of the donor's body) is inserted into the recipient's body and reconnected to the recipient in all necessary ways (blood vessels, ducts, etc.).Surgery_item_2_21
  • arthrodesis – surgical connection of adjacent bones so the bones can grow together into one. Spinal fusion is an example of adjacent vertebrae connected allowing them to grow together into one piece.Surgery_item_2_22
  • modifying the digestive tract in bariatric surgery for weight loss.Surgery_item_2_23
  • repair of a fistula, hernia, or prolapse.Surgery_item_2_24
  • repair according to the ICD-10-PCS, in the Medical and Surgical Section 0, root operation Q, means restoring, to the extent possible, a body part to its normal anatomic structure and function. This definition, repair, is used only when the method used to accomplish the repair is not one of the other root operations. Examples would be colostomy takedown, herniorrhaphy of a hernia, and the surgical suture of a laceration.Surgery_item_2_25
  • other procedures, including:Surgery_item_2_26

Surgery_description_list_3

  • Surgery_item_3_27
    • clearing clogged ducts, blood or other vesselsSurgery_item_3_28
    • removal of calculi (stones)Surgery_item_3_29
    • draining of accumulated fluidsSurgery_item_3_30
    • debridement – removal of dead, damaged, or diseased tissueSurgery_item_3_31

Blood or blood expanders may be administered to compensate for blood lost during surgery. Surgery_sentence_48

Once the procedure is complete, sutures or staples are used to close the incision. Surgery_sentence_49

Once the incision is closed, the anesthetic agents are stopped or reversed, and the person is taken off ventilation and (if general anesthesia was administered). Surgery_sentence_50

Postoperative care Surgery_section_8

After completion of surgery, the person is transferred to the post anesthesia care unit and closely monitored. Surgery_sentence_51

When the person is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. Surgery_sentence_52

During the post-operative period, the person's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. Surgery_sentence_53

There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Surgery_sentence_54

Obesity has long been considered a risk factor for adverse post-surgical outcomes. Surgery_sentence_55

It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications. Surgery_sentence_56

If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way. Surgery_sentence_57

It is not uncommon for surgical drains (see Drain (surgery)) to be required to remove blood or fluid from the surgical wound during recovery. Surgery_sentence_58

Mostly these drains stay in until the volume tapers off, then they are removed. Surgery_sentence_59

These drains can become clogged, leading to abscess. Surgery_sentence_60

Postoperative therapy may include adjuvant treatment such as chemotherapy, radiation therapy, or administration of medication such as anti-rejection medication for transplants. Surgery_sentence_61

Other follow-up studies or rehabilitation may be prescribed during and after the recovery period. Surgery_sentence_62

The use of topical antibiotics on surgical wounds to reduce infection rates has been questioned. Surgery_sentence_63

Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developing contact dermatitis and antibiotic resistance. Surgery_sentence_64

It has also been suggested that topical antibiotics should only be used when a person shows signs of infection and not as a preventative. Surgery_sentence_65

A systematic review published by Cochrane (organisation) in 2016, though, concluded that topical antibiotics applied over certain types of surgical wounds reduce the risk of surgical site infections, when compared to no treatment or use of antiseptics. Surgery_sentence_66

The review also did not find conclusive evidence to suggest that topical antibiotics increased the risk of local skin reactions or antibiotic resistance. Surgery_sentence_67

Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. Surgery_sentence_68

The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. Surgery_sentence_69

This "weekday effect" has been postulated to be from several factors including poorer availability of services on a weekend, and also, decrease number and level of experience over a weekend. Surgery_sentence_70

While pain is universal and expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. Surgery_sentence_71

It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines. Surgery_sentence_72

Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities. Surgery_sentence_73

Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge. Surgery_sentence_74

Epidemiology Surgery_section_9

United States Surgery_section_10

In 2011, of the 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. Surgery_sentence_75

These stays accounted for 48% of the total $387 billion in hospital costs. Surgery_sentence_76

The overall number of procedures remained stable from 2001 to 2011. Surgery_sentence_77

In 2011, over 15 million operating room procedures were performed in U.S. hospitals. Surgery_sentence_78

Data from 2003 to 2011 showed that U.S. hospital costs were highest for the surgical service line; the surgical service line costs were $17,600 in 2003 and projected to be $22,500 in 2013. Surgery_sentence_79

For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure. Surgery_sentence_80

in 2012, mean hospital costs in the United States were highest for surgical stays. Surgery_sentence_81

Special populations Surgery_section_11

Elderly people Surgery_section_12

Older adults have widely varying physical health. Surgery_sentence_82

Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Surgery_sentence_83

Assessment of older people before elective surgery can accurately predict the person's recovery trajectories. Surgery_sentence_84

One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. Surgery_sentence_85

A healthy person scores 0; a very frail person scores 5. Surgery_sentence_86

Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Surgery_sentence_87

People who are frail and elderly (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people. Surgery_sentence_88

Children Surgery_section_13

Surgery on children requires considerations that are not common in adult surgery. Surgery_sentence_89

Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments. Surgery_sentence_90

Bariatric surgery in youth is among the controversial topics related to surgery in children. Surgery_sentence_91

See also: Pediatric surgery and Pediatric plastic surgery Surgery_sentence_92

Vulnerable populations Surgery_section_14

Doctors perform surgery with the consent of the person undergoing surgery. Surgery_sentence_93

Some people are able to give better informed consent than others. Surgery_sentence_94

Populations such as incarcerated persons, people living with dementia, the mentally incompetent, persons subject to coercion, and other people who are not able to make decisions with the same authority as others, have special needs when making decisions about their personal healthcare, including surgery. Surgery_sentence_95

'Global Surgery' in low- and middle-income countries Surgery_section_15

Surgery remains grossly neglected in global health, famously described by Halfdan T. Mahler as the 'neglected stepchild of global health'. Surgery_sentence_96

This particularly affects low-resource settings with weak surgical health systems. Surgery_sentence_97

'Global surgery' is the term now adopted to describe the rapidly developing field seeking to address this, and has been defined as 'the multidisciplinary enterprise of providing improved and equitable surgical care to the world's population, with its core tenets as the issues of need, access and quality'. Surgery_sentence_98

In 2014, The Lancet Commission on Global Surgery was launched to examine the case for surgery as an integral component of global health care and to provide recommendations regarding the delivery of surgical and anesthesia services in low and middle income countries. Surgery_sentence_99

In this study, two primary conclusions were reached: Surgery_sentence_100

Surgery_unordered_list_4

  • Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. Areas in which especially large proportions of the population lack access include Sub-Saharan Africa, the Indian Subcontinent, Central Asia and, to a lesser extent, Russia and China. Of the estimated 312.9 million surgical procedures undertaken worldwide in 2012, only 6.3% were done in countries comprising the poorest 37.3% of the world's population.Surgery_item_4_32
  • An additional 143 million surgical procedures are needed each year to prevent unnecessary death and disability.Surgery_item_4_33

Globally, 4.2 million people are estimated to die within 30 days of surgery each year, with half of these occurring in low- and middle-income countries. Surgery_sentence_101

A prospective study of 10,745 adults undergoing emergency abdominal surgery from 357 centres across 58 countries found that mortality is three times higher in low- compared with high-human development index (HDI) countries even when adjusted for prognostic factors. Surgery_sentence_102

In this study the overall global mortality rate was 1·6 per cent at 24 hours (high HDI 1·1 per cent, middle HDI 1·9 per cent, low HDI 3·4 per cent), increasing to 5·4 per cent by 30 days (high HDI 4·5 per cent, middle HDI 6·0 per cent, low HDI 8·6 per cent; P < 0·001). Surgery_sentence_103

A sub-study of 1,409 children undergoing emergency abdominal surgery from 253 centres across 43 countries found that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Surgery_sentence_104

This translates to 40 excess deaths per 1000 procedures performed in these settings. Surgery_sentence_105

Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days. Surgery_sentence_106

Introducing novel or new surgical techniques in low- and middle-income countries is a challenge. Surgery_sentence_107

Challenges include knowledge (awareness), fear, costs, and cultural beliefs. Surgery_sentence_108

Human rights Surgery_section_16

Access to surgical care is increasingly recognized as an integral aspect of healthcare, and therefore is evolving into a normative derivation of human right to health. Surgery_sentence_109

The ICESCR Article 12.1 and 12.2 define the human right to health as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" In the August 2000, the UN Committee on Economic, Social and Cultural Rights (CESCR) interpreted this to mean "right to the enjoyment of a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable health". Surgery_sentence_110

Surgical care can be thereby viewed as a positive right – an entitlement to protective healthcare. Surgery_sentence_111

Woven through the International Human and Health Rights literature is the right to be free from surgical disease. Surgery_sentence_112

The 1966 ICESCR Article 12.2a described the need for "provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child" which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services". Surgery_sentence_113

Article 12.2d of the ICESCR stipulates the need for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness", and is interpreted in the 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment of injury and disability.". Surgery_sentence_114

Obstetric care shares close ties with reproductive rights, which includes access to reproductive health. Surgery_sentence_115

Surgeons and public health advocates, such as Kelly McQueen, have described surgery as "Integral to the right to health". Surgery_sentence_116

This is reflected in the establishment of the WHO Global Initiative for Emergency and Essential Surgical Care in 2005, the 2013 formation of the Lancet Commission for Global Surgery, the 2015 World Bank Publication of Volume 1 of its Disease Control Priorities "Essential Surgery", and the 2015 World Health Assembly 68.15 passing of the Resolution for Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage. Surgery_sentence_117

The Lancet Commission for Global Surgery outlined the need for access to "available, affordable, timely and safe" surgical and anesthesia care; dimensions paralleled in ICESCR General Comment No. Surgery_sentence_118

14, which similarly outlines need for available, accessible, affordable and timely healthcare. Surgery_sentence_119

History Surgery_section_17

Main articles: History of surgery, Prehistoric medicine, and History of general anesthesia Surgery_sentence_120

Trepanation Surgery_section_18

Surgical treatments date back to the prehistoric era. Surgery_sentence_121

The oldest for which there is evidence is trepanation, in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intracranial pressure and other diseases. Surgery_sentence_122

Ancient Egypt Surgery_section_19

Prehistoric surgical techniques are seen in Ancient Egypt, where a mandible dated to approximately 2650 BC shows two perforations just below the root of the first molar, indicating the draining of an abscessed tooth. Surgery_sentence_123

Surgical texts from ancient Egypt date back about 3500 years ago. Surgery_sentence_124

Surgical operations were performed by priests, specialized in medical treatments similar to today, and used sutures to close wounds. Surgery_sentence_125

Infections were treated with honey. Surgery_sentence_126

India Surgery_section_20

Remains from the early Harappan periods of the Indus Valley Civilization (c. 3300 BC) show evidence of teeth having been drilled dating back 9,000 years. Surgery_sentence_127

Susruta was an ancient Indian surgeon commonly credited as the author of the treatise Sushruta Samhita. Surgery_sentence_128

He is well known as the "father of surgery", and his period is usually placed around 1200–600 BC. Surgery_sentence_129

One of the earliest known mentions of the name is from the Bower Manuscript, in which Sushruta is listed as one of the ten sages residing in the Himalayas. Surgery_sentence_130

Texts suggest that he learned surgery at Kasi from Lord Dhanvantari, the god of medicine in Hindu mythology. Surgery_sentence_131

It is one of the oldest known surgical texts and it describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures for various forms of cosmetic surgery, plastic surgery and rhinoplasty. Surgery_sentence_132

Ancient Greece Surgery_section_21

In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing. Surgery_sentence_133

Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing. Surgery_sentence_134

In the Asclepieion of Epidaurus, some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place. Surgery_sentence_135

The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations – including brain and eye surgery – that were not tried again for almost two millennia. Surgery_sentence_136

Researchers from the Adelphi University discovered in the Paliokastro on Thasos ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery. Surgery_sentence_137

According to the researchers: "The very serious trauma cases sustained by both males and females had been treated surgically or orthopedically by a very experienced physician/surgeon with great training in trauma care. Surgery_sentence_138

We believe it to have been a military physician". Surgery_sentence_139

The researchers were impressed by the complexity of the brain surgical operation. Surgery_sentence_140

Islamic World Surgery_section_22

During the Islamic Golden Age, largely based upon Paul of Aegina's Pragmateia, the writings of Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practiced in the Zahra suburb of Córdoba, were influential. Surgery_sentence_141

Al-Zahrawi specialized in curing disease by cauterization. Surgery_sentence_142

He invented several surgical instruments for purposes such as inspection of the interior of the urethra and for removing foreign bodies from the throat, the ear, and other body organs. Surgery_sentence_143

He was also the first to illustrate the various cannulae and to treat warts with an iron tube and caustic metal as a boring instrument. Surgery_sentence_144

He describes what is thought to be the first attempt at reduction mammaplasty for the management of gynaecomastia and the first mastectomy to treat breast cancer. Surgery_sentence_145

He is credited with the performance of the first thyroidectomy. Surgery_sentence_146

Al-Zahrawi pioneered techniques of neurosurgery and neurological diagnosis, treating head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache. Surgery_sentence_147

The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi, who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children. Surgery_sentence_148

Early modern Europe Surgery_section_23

In Europe, the demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier, Padua and Bologna were particularly renowned. Surgery_sentence_149

In the 12th century, Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals. Surgery_sentence_150

Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a specialty of medicine, rather than an accessory field. Surgery_sentence_151

Basic surgical principles for asepsis etc., are known as Halsteads principles. Surgery_sentence_152

There were some important advances to the art of surgery during this period. Surgery_sentence_153

The professor of anatomy at the University of Padua, Andreas Vesalius, was a pivotal figure in the Renaissance transition from classical medicine and anatomy based on the works of Galen, to an empirical approach of 'hands-on' dissection. Surgery_sentence_154

In his anatomic treaties De humani corporis fabrica, he exposed the many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves. Surgery_sentence_155

The second figure of importance in this era was Ambroise Paré (sometimes spelled "Ambrose"), a French army surgeon from the 1530s until his death in 1590. Surgery_sentence_156

The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Surgery_sentence_157

Paré began to employ a less irritating emollient, made of egg yolk, rose oil and turpentine. Surgery_sentence_158

He also described more efficient techniques for the effective ligation of the blood vessels during an amputation. Surgery_sentence_159

Modern surgery Surgery_section_24

The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe. Surgery_sentence_160

An important figure in this regard was the Scottish surgical scientist, John Hunter, generally regarded as the father of modern scientific surgery. Surgery_sentence_161

He brought an empirical and experimental approach to the science and was renowned around Europe for the quality of his research and his written works. Surgery_sentence_162

Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others, he conducted his own surgical experiments to determine the truth of the matter. Surgery_sentence_163

To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans. Surgery_sentence_164

He greatly advanced knowledge of venereal disease and introduced many new techniques of surgery, including new methods for repairing damage to the Achilles tendon and a more effective method for applying ligature of the arteries in case of an aneurysm. Surgery_sentence_165

He was also one of the first to understand the importance of pathology, the danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and even tuberculosis often undid any benefit that was gained from the intervention. Surgery_sentence_166

He consequently adopted the position that all surgical procedures should be used only as a last resort. Surgery_sentence_167

Other important 18th- and early 19th-century surgeons included Percival Pott (1713–1788) who described tuberculosis on the spine and first demonstrated that a cancer may be caused by an environmental carcinogen (he noticed a connection between chimney sweep's exposure to soot and their high incidence of scrotal cancer). Surgery_sentence_168

Astley Paston Cooper (1768–1841) first performed a successful ligation of the abdominal aorta, and James Syme (1799–1870) pioneered the Symes Amputation for the ankle joint and successfully carried out the first hip disarticulation. Surgery_sentence_169

Modern pain control through anesthesia was discovered in the mid-19th century. Surgery_sentence_170

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. Surgery_sentence_171

This also meant that operations were largely restricted to amputations and external growth removals. Surgery_sentence_172

Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether, first used by the American surgeon Crawford Long, and chloroform, discovered by Scottish obstetrician James Young Simpson and later pioneered by John Snow, physician to Queen Victoria. Surgery_sentence_173

In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. Surgery_sentence_174

In addition, the discovery of muscle relaxants such as curare allowed for safer applications. Surgery_sentence_175

Infection and antisepsis Surgery_section_25

Unfortunately, the introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. Surgery_sentence_176

The concept of infection was unknown until relatively modern times. Surgery_sentence_177

The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Surgery_sentence_178

Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths; however, the Royal Society dismissed his advice. Surgery_sentence_179

Until the pioneering work of British surgeon Joseph Lister in the 1860s, most medical men believed that chemical damage from exposures to bad air (see "miasma") was responsible for infections in wounds, and facilities for washing hands or a patient's wounds were not available. Surgery_sentence_180

Lister became aware of the work of French chemist Louis Pasteur, who showed that rotting and fermentation could occur under anaerobic conditions if micro-organisms were present. Surgery_sentence_181

Pasteur suggested three methods to eliminate the micro-organisms responsible for gangrene: filtration, exposure to heat, or exposure to chemical solutions. Surgery_sentence_182

Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop antiseptic techniques for wounds. Surgery_sentence_183

As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, spraying carbolic acid on his instruments. Surgery_sentence_184

He found that this remarkably reduced the incidence of gangrene and he published his results in The Lancet. Surgery_sentence_185

Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on the Antiseptic Principle of the Practice of Surgery, which was reprinted in The British Medical Journal. Surgery_sentence_186

His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years. Surgery_sentence_187

Lister continued to develop improved methods of antisepsis and asepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. Surgery_sentence_188

This led to the rise of sterile surgery. Surgery_sentence_189

Lister introduced the Steam Steriliser to sterilize equipment, instituted rigorous hand washing and later implemented the wearing of rubber gloves. Surgery_sentence_190

These three crucial advances – the adoption of a scientific methodology toward surgical operations, the use of anaesthetic and the introduction of sterilised equipment – laid the groundwork for the modern invasive surgical techniques of today. Surgery_sentence_191

The use of X-rays as an important medical diagnostic tool began with their discovery in 1895 by German physicist Wilhelm Röntgen. Surgery_sentence_192

He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treated photographic plate. Surgery_sentence_193

Surgery_unordered_list_5

  • Surgery_item_5_34
  • Surgery_item_5_35
  • Surgery_item_5_36

Surgical specialties Surgery_section_26

Learned societies Surgery_section_27

See also Surgery_section_28

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Surgery.