Information about Surgical

In medicine, surgery (from the Greek χειρουργική meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. Persons described as surgeons are commonly medical practitioners, but the term is also applied to dentists and veterinarians.

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

History

Main article: History of surgery

At least two prehistoric cultures had developed forms of surgery. The oldest for which we have evidence is trepannation,^[1] 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. Evidence has been found in prehistoric human remains from Neolithic times, in cave paintings, and the procedure continued in use well into recorded history. Surprisingly, many prehistoric and premodern patients had signs of their skull structure healing; suggesting that many survived the operation. In modern-day Pakistan, 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.^[2] A final candidate for prehistoric surgical techniques is 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. Recent excavations of the construction workers of the Egyptian pyramids also led to possible evidence of brain surgery.

The oldest known surgical texts date back to Indian physician Sushruta, the "Father of Surgery", who taught and practiced surgery on the banks of the Ganges around 600 BC. 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 great 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.^[3] His technique for the latter, used to reconstruct noses that were amputated as a punishment for crimes, is practiced almost unchanged in technique to this day.

Other ancient cultures to have surgical knowledge include ancient Greece - the Hippocratic Oath was an innovation of the Greek physician Hippocrates - and ancient China. However ancient Greek culture traditionally considered the practice of opening the body to be repulsive and thus left known surgical practices such as lithotomy to such persons as practice [it]. In 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.

In the Middle Ages, surgery was developed to a high degree in the Islamic world, with renowned practitioners such as Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Córdoba. A great medieval surgeon, whose comprehensive medical texts shaped European surgical procedures up until the Renaissance. He is also often regarded as a Father Of Surgery.^[4]

In Europe, the demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier, Padua and Bologna Universities were particularly renowned. By the fifteenth century at the latest, surgery had split away from physics as its own subject, of a lesser status than pure medicine, and initially took the form of a craft tradition until Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals up to the modern time.

Modern surgery

Modern surgery developed rapidly with the scientific era. Ambroise Paré pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the Napoleonic Wars. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches - control of bleeding, control of infection and control of pain (anaesthesia).

Bleeding: Before modern surgical developments, there was a very real threat that a patient would bleed to death before treatment, or during the operation. cauterization (fusing a wound closed with extreme heat) was successful but limited - it was destructive, painful and in the long term had very poor outcomes. Ligatures, or material used to tie off severed blood vessels, are believed to have originated with Ambroise Pare (sometimes spelled "Ambrose"^[5]) during the 16th century, but were highly dangerous until infection risk was brought under control - at the time of its discovery, the concept of infection did not exist. Finally, early 20th century research into blood groups allowed the first effective blood transfusions. ; Infection: The concept of infection was unknown until relatively modern times. 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. 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 in the UK still dismissed his advice. Significant progress came following the work of Pasteur, when the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly reduce infection rates, a reduction that was further helped by his subsequent introduction of techniques to sterilize equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in The Lancet (March 1867) under the title Antiseptic Principle of the Practice of Surgery. The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime). ; Pain: Modern pain control (anesthesia) was discovered by two American dentists, Horace Wells (1815-1848) and William Morton. 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. 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, later pioneered in Britain by John Snow. 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.

Conditions treated by surgery

Surgery is used to both as a treatment, and as an aspect of treatment, for many conditions, including:

• Physical trauma, e.g. wounds
• Anatomical Abnormalities
• Disorders of function
• Inflammation
• Ischaemia and infarction
• Metabolic disorders
• Neoplasia
• Other abnormalities of tissue growth, e.g. cysts, hyperplasia or Organ hypertrophy, as well as some cancers, if caught early enough
• Deformity and heavy scarring.
• Brain damage and nerve damage

Common procedures

Four of the most common surgical procedures in the United States 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, appendectomy, cataract surgery, circumcision, dental extraction and 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.

See also

• Anesthesia
• ASA score or pre-operative physical fittness
• Biomaterial
• Cardiac surgery
• Drain
• Endoscopy
• FACS
• Hypnosurgery
• Knot
• List of surgical procedures
• Minimally invasive procedure
• Perioperative mortality
• Surgeon
• Traumatology

References

External links

• Surgery Videos
• Surgeons Net Educational Site
• Comparison of shoulder scars for open verses arthroscopic surgeries
• The portrayal of surgery by various artists
• 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.
• An On-Line Surgery Journal Club (via JournalReview.org)
• United States Surgery Patents
• American Surgical Association
• Unmanned robot surgeon
• AO Surgery Reference
• The Imperial College London Surgical Society

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