Surgery

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

Ancient Egypt

Researchers have uncovered an Ancient Egyptian mandible, dated to approximately 2650 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.

Ancient Greece

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.

Ancient India

Indian physician Sushruta (c. 600 BC) taught and practiced surgery on the banks of the Ganges in the area that corresponds to the present day city of Benares in Northern India. Much of what is known about Sushruta 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, as well as procedures on performing various forms of plastic surgery, such as cosmetic surgery and rhinoplasty.

Ancient China

Hua Tuo was a famous Chinese physician during the Eastern Han and Three Kingdoms era. He was the first person to perform surgery with the aid of anesthesia, some 1600 years before the practice was adopted by Europeans.

Medieval Europe

Abulcasis was an Andalusian-Arab physician and scientist who praticised in the Zahra suburb of Cordova. He is considered a great medieval surgeon, whose comprehensive medical texts, combining Middle Eastern and Greco-Roman classical teachings, shaped European surgical procedures up until the Renaissance. He is often regarded as the Father Of Surgery. Patients and students from all parts of Europe came to him for treatment and advice. According to Will Durant, Cordova was in this period the favourite resort of Europeans for surgical operations.

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.

Europe

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 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. 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 Britain, John Snow pioneered the use of these two anaesthetics. 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.

Doctor or Mister?

In the United Kingdom, Australia, South Africa 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 are Fellows of the Royal College of Surgeons generally call themselves Mister, Miss, Mrs or Ms in the course of their professional practice.

By contrast, North American physicians and surgeons are always addressed as "Doctor." The title of doctor is represented in a physician and surgeon's name by the title M.D., D.O., D.M.D. or D.P.M. following his/her surname.

Diseases that can be treated by surgery

• Trauma
• Anatomical Abnormalities
• Disorders of function
• Inflammation
• Ischaemia and infarction
• Metabolic disorders
• Neoplasia
• Other abnormalities of tissue growth, e.g. cysts, hyperplasia or Organ 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 surgical procedures include:
  • amputation
  • appendicectomy
  • circumcision
  • dental extraction
  • herniorraphy

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 operations.

Noted surgeons

• Sushruta (known as "father of surgery", inventor of plastic surgery)
• 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)
• John Hunter (Scottish, viewed as the father of modern surgery, performed hundreds of dissections, served as the model for Dr. Jekyll.)
• Sir Victor Horsley (neurosurgery)
• Lars Leksell (neurosurgery, inventor of radiosurgery)
• Joseph Lister (discoverer of surgical sepsis, Listerine named in his honour)
• Harvey Cushing (pioneer of brain surgery)
• Joseph Pancoast - 19th century American surgeon
• Gavril Ilizarov a Russian orthopedic surgeon who invented the procedure to lengthen or reshape limb bones.
• Svyatoslav Fyodorov, a Russian ophthalmologist, eye microsurgeon, creator of radial keratotomy.
• Gazi Yasargil, Turkish neurosurgeon Father of microsurgery (neurosurgery)

Surgical Procedures and Techniques

• List of surgical procedures
• Abdominal surgery
• Cardiothoracic surgery
• Dental surgery
• Ophthalmic Surgery
• Orthopedic surgery
• General surgery
• Laparoscopic surgery
• Neurosurgery
• NOTES
• Oral and Maxillofacial Surgery
• Otorhinolaryngology
• Plastic surgery
• Remote surgery
• Sexual reassignment surgery
• Urology
• Vascular surgery