The act of performing surgery may be called asurgical procedure orsurgical operation, or simply "surgery" or "operation". In this context, the verb "operate" means to perform surgery. The adjectivesurgical means pertaining to surgery; e.g.surgical instruments,surgical facility orsurgical nurse. Most surgical procedures are performed by a pair of operators: asurgeon who is the main operator performing the surgery, and asurgical assistant who provides in-procedure manual assistance during surgery. Modern surgical operations typically require asurgical team that typically consists of the surgeon, the surgical assistant, ananaesthetist (often also complemented by ananaesthetic nurse), ascrub nurse (who handlessterile equipment), acirculating nurse and asurgical technologist, while procedures that mandatecardiopulmonary bypass will also have aperfusionist. All surgical procedures are consideredinvasive and often require a period ofpostoperative care (sometimesintensive care) for the patient to recover from theiatrogenic trauma inflicted by the procedure. The duration of surgery can span from several minutes to tens of hours depending on thespecialty, the nature of the condition, the targetbody parts involved and the circumstance of each procedure, but most surgeries are designed to be one-off interventions that are typically not intended as an ongoing or repeated type of treatment.
Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation.
Elective surgery is done to correct a non-life-threatening condition, and is carried out at the person's convenience, or to the surgeon's and the surgical facility's availability.
Semi-elective surgery is one that is better done early to avoid complications or potential deterioration of the patient's condition, but such risk are sufficiently low that the procedure can be postponed for a short period time.
Emergency surgery is surgery which must be done without any delay to prevent death or serious disabilities or loss of limbs and functions.
Non-survival surgery, or terminal surgery, is whereEuthanasia is performed while the subject is underAnesthesia so that the subject will not regain conscious pain perception.[5] This type of surgery is usually done inAnimal testing experiments.[6]
Repair involves the direct closure or restoration of an injured, mutilated or deformed organ or body part, usually bysuturing orinternal fixation.Reconstruction is an extensive repair of a complex body part (such asjoints), often with some degrees of structural/functional replacement and commonly involves grafting and/or use of implants.
Grafting is the relocation and establishment of a tissue from one part of the body to another. Aflap is the relocation of a tissue without complete separation of its original attachment, and afree flap is a completely detached flap that carries an intact neurovascular structure ready for grafting onto a new location.
Bypass involves the relocation/grafting of a tubular structure onto another in order to reroute the content flow of that target structure from a specific segment directly to a more distal ("downstream") segment.
Transplantation is the replacement of an organ or body part by insertion of another from a different human (or animal) into the person undergoing surgery.Harvesting is the resection of an organ or body part from a live human or animal (known as thedonor) for transplantation into another patient (known as therecipient).
Byorgan system: Surgical specialties are traditionally and academically categorized by the organ, organ system or body region involved. Examples include:
Conventionalopen surgery (such as alaparotomy) requires a large incision to access the area of interest, and directly exposes the internal body cavity to the outside.
Hybrid surgery uses a combination of open and minimally-invasive techniques, and may include hand ports or larger incisions to assist with performance of elements of the procedure.
Microsurgery involves the use of an operatingmicroscope for the surgeon to see and manipulate small structures.
Endoscopic surgery usesoptical instruments to relay the image from inside an enclosed body cavity to the outside, and the surgeon performs the procedure using specialized handheld instruments inserted throughtrocars placed through the body wall. Most modern endoscopic procedures arevideo-assisted, meaning the images are viewed on adisplay screen rather than through theeyepiece on the endoscope.
Resection and excisional procedures start with aprefix for the target organ to be excised (cut out) and end in thesuffix-ectomy. For example, removal of part of the stomach would be called a subtotal gastrectomy.
Procedures involving cutting into an organ or tissue end in-otomy. A surgical procedure cutting through theabdominal wall to gain access to theabdominal cavity is alaparotomy.
Minimally invasive procedures, involving small incisions through which an endoscope is inserted, end in -oscopy. For example, such surgery in the abdominal cavity is calledlaparoscopy.
Procedures for formation of a permanent or semi-permanent opening called astoma in the body end in-ostomy, such as creation of a colostomy, a connection of colon and the abdominal wall. This prefix is also used for connection between two viscera, such as how an esophagojejunostomy refers to a connection created between the esophagus and the jejunum.
Plastic and reconstruction procedures start with the name for the body part to be reconstructed and end in-plasty. For example,rhino- is a prefix meaning "nose", therefore arhinoplasty is a reconstructive or cosmetic surgery for the nose. A pyloroplasty refers to a type of reconstruction of the gastric pylorus.
Procedures that involve cutting the muscular layers of an organ end in-myotomy. A pyloromyotomy refers to cutting the muscular layers of the gastric pylorus.
Repair of a damaged or abnormal structure ends in-orraphy. This includes herniorrhaphy, another name for a hernia repair.
Reoperation, revision, or "redo" procedures refer to a planned or unplanned return to the operating theater after a surgery is performed to re-address an aspect of patient care. Unplanned reasons for reoperation include postoperativecomplications such asbleeding or hematoma formation, development of aseroma orabscess, anastomotic leak, tissuenecrosis requiringdebridement or excision, or in the case of malignancy, close or involvedresection margins that may require re-excision to avoid local recurrence. Reoperation can be performed in the acute phase, or it can be also performed months to years later if the surgery failed to solve the indicated problem. Reoperation can also be planned as a staged operation where components of the procedure are performed or reversed under separate anesthesia.
Inpatient surgery is performed in a hospital, and the person undergoing surgery stays at least one night in the hospital after the surgery.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.[9] Office-based surgery occurs in a physician's office, and the person is discharged the same day.[10]
At ahospital, modern surgery is often performed in anoperating theater usingsurgical instruments, anoperating table, and other equipment. Among United States hospitalizations for non-maternal and non-neonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures.[11] The environment and procedures used in surgery are governed by the principles ofaseptic technique: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must besterilized, 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). 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.
Prior to surgery, the person is given amedical examination, receives certain pre-operative tests, and theirphysical status is rated according to theASA physical status classification system. If these results are satisfactory, the person requiring surgery signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, anautologousblood donation may be made some weeks prior to surgery. If the surgery involves thedigestive system, the person requiring surgery may be instructed to perform abowel prep by drinking a solution ofpolyethylene glycol the night before the procedure. People preparing for surgery are also instructed to abstain from food or drink (anNPO 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.[12]
Some medical systems have a practice of routinely performing chest x-rays before surgery. 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.[13] However,medical specialtyprofessional organizations recommend against routine pre-operativechest x-rays for people who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray.[13] 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.[13] Likewise, other tests includingcomplete blood count,prothrombin time,partial thromboplastin time,basic metabolic panel, andurinalysis should not be done unless the results of these tests can help evaluate surgical risk.[14]
A surgical team may include a surgeon, anesthetist, a circulating nurse, and a "scrub tech", or surgical technician, as well as other assistants who provide equipment and supplies as required. While informed consent discussions may be performed in a clinic or acute care setting, the pre-operative holding area is where documentation is reviewed and where family members can also meet the surgical team. Nurses in the preoperative holding area confirm orders and answer additional questions of the family members of the patient prior to surgery. In the pre-operative holding area, the person preparing for surgery changes out of their street clothes and are asked to confirm the details of his or her surgery as previously discussed during the process of informed consent. A set of vital signs are recorded, a peripheralIV line is placed, and pre-operative medications (antibiotics, sedatives, etc.) are given.[15]
When the patient enters the operating room and is appropriately anesthetized, the team will then position the patient in an appropriatesurgical position. If hair is present at the surgical site, it is clipped (instead of shaving). The skin surface within theoperating field is cleansed and prepared by applying anantiseptic (typicallychlorhexidine gluconate in alcohol, as this is twice as effective aspovidone-iodine at reducing the risk of infection).[16] Sterile drapes are then used to cover the borders of theoperating field. Depending on the type of procedure, the cephalad drapes are secured to a pair of poles near the head of the bed to form an "ether screen", which separate theanesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).[17]
Anesthesia is administered to preventpain from the trauma of cutting, tissue manipulation, application of thermal energy, and suturing. Depending on the type of operation, anesthesia may be providedlocally, regionally, or asgeneral anesthesia.Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the person can remain conscious or minimally sedated. In contrast, general anesthesia may render the person unconscious and paralyzed during surgery. The person is typicallyintubated to protect their airway and placed on amechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents. The choice of surgical method andanesthetic technique aims to solve the indicated problem, minimize the risk of complications, optimize the time needed for recovery, and limit thesurgical stress response.
The intraoperative phase begins when the surgery subject is received in the surgical area (such as theoperating theater or surgicaldepartment), and lasts until the subject is transferred to a recovery area (such as apost-anesthesia care unit).[18]
An incision is made to access the surgical site.Blood vessels may be clamped orcauterized to prevent bleeding, and retractors may be used to expose the site or keep the incision open. 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. In certain cases,bone may be cut to further access the interior of the body; for example, cutting theskull forbrain surgery or cutting thesternum forthoracic (chest) surgery to open up therib cage. Whilst in surgeryaseptic technique is used to prevent infection or further spreading of the disease. 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. An antiseptic solution is applied to the area of the person's body that will be operated on. Sterile drapes are placed around the operative site. 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.[citation needed]
Work to correct the problem in body then proceeds. This work may involve:
excision – cutting out an organ, tumor,[19] or other tissue.
resection – partial removal of an organ or other bodily structure.[20]
reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internalsuturing or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is calledanastomosis.[21]
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.[22]
ligation – tying off blood vessels, ducts, or "tubes".[23]
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 isbypass 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.[24]
insertion ofprosthetic 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.[25]Heart pacemakers orvalves may be inserted. Many other types ofprostheses are used.
creation of astoma, a permanent or semi-permanent opening in the body[26]
intransplant 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.).[27]
arthrodesis – surgical connection of adjacent bones so the bones can grow together into one.Spinal fusion is an example of adjacentvertebrae connected allowing them to grow together into one piece.[28]
repair according to theICD-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 becolostomy takedown,herniorrhaphy of ahernia, and thesurgical suture of alaceration.[29]
other procedures, including:
clearing clogged ducts, blood or other vessels
removal of calculi (stones)
draining of accumulated fluids
debridement – removal of dead, damaged, or diseased tissue
Blood or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete,sutures orstaples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the person is taken off ventilation andextubated (if general anesthesia was administered).[30]
After completion of surgery, the person is transferred to thepost anesthesia care unit and closely monitored. 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. 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. There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesityhypoventilation syndrome,atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications.[31] 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.[citation needed]
It is not uncommon forsurgical drains to be required to remove blood or fluid from the surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading toabscess.[32]
Postoperative therapy may includeadjuvant treatment such aschemotherapy,radiation therapy, or administration ofmedication such asanti-rejection medication for transplants. For postoperative nausea and vomiting (PONV), solutions like saline, water, controlled breathing placebo and aromatherapy can be used in addition to medication.[33] Other follow-up studies orrehabilitation may be prescribed during and after the recovery period. A recent post-operative care philosophy has been early ambulation. Ambulation is getting the patient moving around. This can be as simple as sitting up or even walking around. The goal is to get the patient moving as early as possible. It has been found to shorten the patient's length of stay. Length of stay is the amount of time a patient spends in the hospital after surgery before they are discharged. In a recent study[34] done with lumbar decompressions, the patient's length of stay was decreased by 1–3 days.
The use oftopical antibiotics on surgical wounds to reduce infection rates has been questioned.[35] Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developingcontact dermatitis andantibiotic resistance.[35] It has also been suggested that topical antibiotics should only be used when a person shows signs of infection and not as a preventative.[35] A systematic review published byCochrane (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 ofantiseptics.[36] The review also did not find conclusive evidence to suggest that topical antibiotics increased the risk of local skin reactions or antibiotic resistance.[citation needed]
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. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. 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.[37]
Postoperative pain affects an estimated 80% of people who underwent surgery.[38] While pain is expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines.[39] There is insufficient evidence to determine if giving opioid pain medication pre-emptively (before surgery) reduces postoperative pain the amount of medication needed after surgery.[38]
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.[40] Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge.[citation needed]
This section needs to beupdated. Please help update this article to reflect recent events or newly available information.(February 2025)
In 2011, of the 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $387 billion in hospital costs.[41]
The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals.[42]
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.[43] For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure.[44] in 2012, mean hospital costs in the United States were highest for surgical stays.[44]
Older adults have widely varying physical health.Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Assessment of older people before elective surgery can accurately predict the person's recovery trajectories.[45] One frailty scale uses five items: unintentional weight loss,muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. 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.[45] 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.[citation needed]
Surgery on children requires considerations that are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments.Bariatric surgery in youth is among the controversial topics related to surgery in children.[citation needed]
Doctors perform surgery with the consent of the person undergoing surgery. Some people are able to give betterinformed consent than others. Populations such asincarcerated 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.
Global surgery has been defined as 'themultidisciplinary enterprise of providing improved and equitable surgical care to the world's population, with its core belief as the issues of need, access and quality".[46]Halfdan T. Mahler, the 3rd Director-General ofthe World Health Organization (WHO), first brought attention to the disparities in surgery and surgical care in 1980 when he stated in his address to the World Congress of the International College of Surgeons, "'the vast majority of the world's population has no access whatsoever to skilled surgical care and little is being done to find a solution.As such, surgical care globally has been described as the 'neglected stepchild of global health,' a term coined byPaul Farmer to highlight the urgent need for further work in this area.[47] Furthermore,Jim Young Kim, the former President of theWorld Bank, proclaimed in 2014 that "surgery is an indivisible, indispensable part of health care and of progress towards universal health coverage."[48]
In 2015, the Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030.[49] The Commission highlighted that about 5 billion people lack access to safe and affordable surgical and anesthesia care and 143 million additional procedures were needed every year to prevent furthermorbidity andmortality from treatable surgical conditions as well as a $12.3 trillion loss in economic productivity by the year 2030.[49] This was especially true in the poorest countries, which account for over one-third of the population but only 3.5% of all surgeries that occur worldwide.[50] It emphasized the need to significantly improve the capacity for Bellwether procedures –laparotomy,caesarean section,open fracture care – which are considered a minimum level of care that first-level hospitals should be able to provide in order to capture the most basic emergency surgical care.[49][51] In terms of the financial impact on the patients, the lack of adequate surgical and anesthesia care has resulted in 33 million individuals every year facing catastrophic health expenditure – the out-of-pocket healthcare cost exceeding 40% of a given household's income.[49][52]
In alignment with the LCoGS call for action, theWorld Health Assembly adopted the resolution WHA68.15 in 2015 that stated, "Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage."[53] This not only mandated theWHO to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. Additionally, the third edition ofDisease Control Priorities (DCP3), published in 2015 by theWorld Bank, declared surgery as essential and featured an entire volume dedicated to building surgical capacity.[54]
Data from WHO and the World Bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment.[55] In fact, a systematic review found that thecost-effectiveness ratio – dollars spent per DALYs averted – for surgical interventions is on par or exceeds those of major public health interventions such asoral rehydration therapy,breastfeeding promotion, and evenHIV/AIDS antiretroviral therapy.[56] This finding challenged the common misconception that surgical care is financially prohibitive endeavor not worth pursuing in LMICs.
A key policy framework that arose from this renewed global commitment towards surgical care worldwide is the National Surgical Obstetric and Anesthesia Plan (NSOAP).[57] NSOAP focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. This approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. Successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support.[57]
Access to surgical care is increasingly recognized as an integral aspect of healthcare and therefore is evolving into a normative derivation of humanright to health.[58] TheICESCR Article 12.1 and 12.2 define the humanright to health as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health"[59] In the August 2000, the UNCommittee 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".[60] Surgical care can be thereby viewed as a positive right – an entitlement to protective healthcare.[60]
Woven through the International Human and Health Rights literature is the right to be free from surgical disease. 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"[61] which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services".[60] 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",[62] and is interpreted in the 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment ofinjury anddisability.".[63] Obstetric care shares close ties withreproductive rights, which includes access to reproductive health.[63]
Surgical treatments date back to the prehistoric era. The oldest for which there is evidence istrepanation,[67] in which a hole isdrilled or scraped into theskull, thus exposing thedura mater in order to treat health problems related to intracranial pressure.
Prehistoric surgical techniques are seen inAncient Egypt, where amandible dated to approximately 2650 BC shows two perforations just below the root of the firstmolar, indicating the draining of anabscessed tooth. Surgical texts from ancient Egypt date back about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today,[68] and used sutures to close wounds.[69] Infections were treated with honey.[70]
9,000-year-old skeletal remains of a prehistoric individual from theIndus River valley show evidence of teeth having been drilled.[71]Sushruta Samhita is one of the oldest known surgical texts and its period is usually placed in the first millennium BCE.[72] 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 andrhinoplasty.[73]
In 1982 archaeologists were able to find significant evidence when the ancient land, called 'Alahana Pirivena' situated in Polonnaruwa, with ruins, was excavated. In that place ruins of an ancient hospital emerged. The hospital building was 147.5 feet in width and 109.2 feet in length. The instruments which were used for complex surgeries were there among the things discovered from the place, including forceps, scissors, probes, lancets, and scalpels. The instruments discovered may be dated to 11th century AD.[74][75][76][77]
Researchers from theAdelphi University discovered in the Paliokastro onThasos 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. 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. We believe it to have been a military physician". The researchers were impressed by the complexity of the brain surgical operation.[80]
In 1991 at the Polystylon fort in Greece, researchers discovered the head of a Byzantine warrior of the 14th century. Analysis of the lower jaw revealed that a surgery has been performed, when the warrior was alive, to the jaw which had been badly fractured and it tied back together until it healed.[81]
Illuminated miniature of 12th-century eye surgery in ItalyAmbroise Paré (c. 1510–1590), father of modern military surgery.
InEurope, the demand grew for surgeons to formally study for many years before practicing; universities such asMontpellier,Padua andBologna were particularly renowned. In the 12th century,Rogerius Salernitanus composed hisChirurgia, laying the foundation for modern Western surgical manuals.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.[88] Basic surgical principles for asepsis etc., are known asHalsteads principles.
There were some important advances to the art of surgery during this period. The professor of anatomy at theUniversity of Padua,Andreas Vesalius, was a pivotal figure in theRenaissance transition from classical medicine and anatomy based on the works ofGalen, to an empirical approach of 'hands-on' dissection. In his anatomic treatiesDe humani corporis fabrica, he exposed the many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves.[citation needed]
The second figure of importance in this era wasAmbroise Paré (sometimes spelled "Ambrose"[89]), a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Paré began to employ a less irritating emollient, made ofegg yolk,rose oil andturpentine. He also described more efficient techniques for the effectiveligation of theblood vessels during anamputation.[citation needed]
The discipline of surgery was put on a sound, scientific footing during theAge of Enlightenment in Europe. An important figure in this regard was the Scottish surgical scientist,John Hunter, generally regarded as the father of modern scientific surgery.[90] He brought anempirical andexperimental approach to the science and was renowned around Europe for the quality of his research and his written works. 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. 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.[citation needed]
He greatly advanced knowledge ofvenereal disease and introduced many new techniques of surgery, including new methods for repairing damage to theAchilles tendon and a more effective method for applying ligature of thearteries in case of ananeurysm.[91] He was also one of the first to understand the importance ofpathology, the danger of the spread ofinfection and how the problem ofinflammation of the wound, bonelesions and eventuberculosis often undid any benefit that was gained from the intervention. He consequently adopted the position that all surgical procedures should be used only as a last resort.[92]
Other important 18th- and early 19th-century surgeons includedPercival Pott (1713–1788) who describedtuberculosis on the spine and first demonstrated that a cancer may be caused by an environmentalcarcinogen (he noticed a connection betweenchimney sweep's exposure to soot and their high incidence ofscrotal cancer).Astley Paston Cooper (1768–1841) first performed a successful ligation of the abdominal aorta, andJames Syme (1799–1870) pioneered the Symes Amputation for theankle joint and successfully carried out the firsthip disarticulation.
Modernpain control throughanesthesia was discovered in the mid-19th century. Before the advent ofanesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patientsuffering. This also meant that operations were largely restricted toamputations 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 asether, first used by the American surgeonCrawford Long, andchloroform, discovered by Scottish obstetricianJames Young Simpson and later pioneered byJohn Snow, physician toQueen Victoria.[93] In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery ofmuscle relaxants such ascurare allowed for safer applications.[citation needed]
The introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by theHungarian doctorIgnaz 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, theRoyal Society dismissed his advice.[citation needed]
Until the pioneering work of British surgeonJoseph Lister in the 1860s, most medical men believed that chemical damage from exposures to bad air (see "miasma") was responsible forinfections in wounds, and facilities for washing hands or a patient'swounds were not available.[94] Lister became aware of the work of FrenchchemistLouis Pasteur, who showed that rotting andfermentation could occur underanaerobic conditions ifmicro-organisms were present. Pasteur suggested three methods to eliminate themicro-organisms responsible forgangrene: filtration, exposure to heat, or exposure tochemical solutions. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to developantiseptic techniques for wounds. As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, sprayingcarbolic acid on his instruments. He found that this remarkably reduced the incidence of gangrene and he published his results inThe Lancet.[95] Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on theAntiseptic Principle of the Practice of Surgery, which was reprinted in theBritish Medical Journal.[96][97][98] 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.[citation needed]
Lister continued to develop improved methods ofantisepsis andasepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. Lister introduced the Steam Steriliser tosterilize equipment, instituted rigorous hand washing and later implemented the wearing of rubber gloves. 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.
The use ofX-rays as an important medical diagnostic tool began with their discovery in 1895 by GermanphysicistWilhelm Röntgen. He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treatedphotographic plate.
Physician Assistant – Mid-level health care providerPages displaying short descriptions of redirect targets
Remote surgery – ability for a doctor to perform surgery on a patient even though they are not physically in the same locationPages displaying wikidata descriptions as a fallback
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