Surgery (from the Greek: χειρουργική cheirourgikē, via Latin: chirurgiae, meaning "hand work") is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason. An act of performing surgery may be called a surgical procedure, operation, or simply surgery. In this context, the verb operating means performing surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse.
The following are books published by Gryphon Editions in the Classics of Surgery Library. Included in the Classics of Surgery Library are historic medical operation titles and surgical procedure titles. Each book in this series is bound in full genuine leather.
Surgical observations on the constitutional origin and treatment of local diseases and on aneurysms by John Abernethy - 1984
General Surgical Pathology and Therapeutics in Fifty Lectures for Students and Physicians by Theodor Billroth - 1984
The Edwin Smith Surgical Papyrus by James Henry Breasted - 1984
On Lesions of the Vascular System, Diseases of the Rectum, and Other Surgical Complaints by Baron Dupuytren - 1984
Surgical Papers by William Stewart Halsted - 2 volumes - 1984
The Apologie and Treatise of Ambroise Pare Containing the Voyages Made Into Divers Places with Many of His Writings Upon Surgery - 1984
Paulus Aegineta on Surgery: Containing books VI & IV of The seven books of Paulus Aegineta - 1985
An Experimental and Clinical Research into Certain Problems relating to Surgical Operations by George W. Crile - 1985
The Genuine Works of Hippocrates - 1985
A Treatise on the Blood Inflammation, and Gun-Shot Wounds by John Hunter - 1985
Memoirs of Military Surgery and Campaigns of the French Armies by Dominique Jean Larrey - 1985
The Chirurgical Works of Percivall Pott - 1985
A treatise on the high operation for the stone / A history of the high operation for the stone by William Cheselden and J. C. Carpue - 1986
Surgical Essays Part I and Part II of Sir Astley Cooper and Benjamin Travers - 1986
Experimental Surgery by Nicholas Senn - 1986
Intestinal Obstruction Together with Peritonitis by Frederick Treves - 1986
Selected Papers in Physiology and Vascular Surgery by Alexis Carrel - 1987
The Collected Papers of Joseph Baron Lister (2 volumes) - 1987
The Whole Course of Chirurgerie by Peter Lowe - 1987
The use of the laryngoscope in diseases of the throat with an appendix on rhinoscopy by Sir Morell Mackenzie - 1987
Aequanimitas with Other Addresses to Medical Students, Nurses and Practitioners of Medicine by William Osler - 1987
Medical and Surgical Memoirs by Nation Smith - 1987
A Treatise on Hernia by Antonio Scarpa - 1988
The Roentgen Rays in Medicine and Surgery: As an Aid in Diagnosis and a Therapeutic Agent by Francis H. Williams - 1988
Sir Astley Cooper's Lectures on Surgery (2 volumes) - 1989
Cancer of The Rectum / Regional Ileitis by W. Ernest Miles and Burrill B. Crohn - 1989
The Surgery of Pain by René Leriche - 1989
The Principles of Surgery by Nicholas Senn - 1989
The Principles of Surgery by James Syme - 1989
Principles of surgical care: Shock and other problems by Alfred Blalock - 1990
An Account of Two Successful Operations for Restoring a Lost Nose from the Integuments of the Forehead by J. C. Carpue - 1990
Surgery of the Head by Harvey Cushing - 1990
The Surgery of Head and Neck by Levi Cooper Lane - 1990
Silver Sutures in Surgery / Clinical Notes on Uterine Surgery by J. Marion Sims - 1990
The Shoulder Rupture of The Suprasprinatus Tendon And Other Lesions in Or About The Subacromial Bursa by E.A. Codman - 1991
Benign Tumors in the Third Ventricle of the Brain: Diagnosis and Treatment by Walter Dandy - 1991
A System of Surgery; Pathological, Diagnostic, Therapeutic, and Operative by Samuel D. Gross - 2 volumes - 1991
The Healing Hand: Man and Wound in the Ancient World by Guido Majno - 1991
The Therapeutic Problems in Bowel Obstruction by Owen Wangensteen - 1991
Operative Gynecology by Howard Kelly - 2 volumes - 1992
De Aneurysmatibus (Aneurysms) by Giovanni Maria Lancisi - 1992
On Chloroform and Other Anesthetics: Their Action and Administration by John Snow - 1992
The Puzzle People: Memoirs of a Transplant Surgeon by Thomas E. Starzl - 1992
The Morbid Anatomy of Some of the Most Important Parts of the Human Body by Matthew Baillie - 1994
Experiments and observations on the gastric juice and the physiology of digestion by William Beaumont - 1994
Surgical Treatment of Diseases of the Brain by Ernst von Bergmann - 1994
Autobiography of Samuel D. Gross - 1994
The Aphorisms of Hippocrates - 1994
The etiology, the concept and the prophylaxis of childbed fever by- Ignaz F. Semmelweis - 1994
Orthopaedia: Or, the Art of Correcting and Preventing Deformities in Children by Nicolas Andry - 2 volumes - 1995
Religio Medici: Together with a Letter to a Friend on the Death of His Intimate Friend and Christian Morals by Sir Thomas Browne - 1995
Medical Education in the United States and Canada by Abraham Flexner - 1997
Medical ethics or a code of institutes and precepts, adapted to the professional conduct of physicians and surgeons by Thomas Percival - 1997
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The patient or subject on which the surgery is performed can be a person or an animal. A surgeon is a person who performs operations on patients. Persons described as surgeons are commonly medical practitioners, but the term is also applied to podiatrists, dentists and veterinarians. Surgery can last from minutes to hours, but is typically not an ongoing or periodic type of treatment. The term surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.
Definition
Surgery is a medical technology consisting of a physical intervention on tissues. As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound. 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. 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).
History
At least two prehistoric cultures had developed forms of surgery. 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. 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 ancient India, 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. 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.
The oldest known surgical texts date back to ancient Egyptian about 3500 years ago. Surgeries were performed by priests, specialized in medical treatments similar to today. The procedures were documented on papyrus and were the first to describe patient case files; the Edwin Smith Papyrus (held in the New York Academy of Medicine) documents surgical procedures based on anatomy and physiology, while the Ebers Papyrus describes healing based on magic. Their medical expertise was later documented by Herodotus: "The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases."
Other ancient cultures to have surgical knowledge include Ancient India, China and Greece.
Sushruta (also spelled Susruta or Sushrutha) (c. 6th century BC) was a renowned surgeon of Ancient India, and the author of the book Sushruta Samhita. In his book, he described over 120 surgical instruments, 300 surgical procedures and classifies human surgery into 8 categories. Sushruta is also known as the father of plastic surgery and cosmetic surgery. He was a surgeon from the dhanvantari school of Ayurveda.
The Hippocratic Oath was an innovation of the Greek physician Hippocrates. 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, albeit a rudimentary and unsophisticated form.
In the Middle Ages, surgery was developed to a high degree in the Islamic world. Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Córdoba, wrote medical texts that shaped European surgical procedures up until the Renaissance. He is also often regarded as a Father of Surgery.
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. 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. Late in the nineteenth century, Bachelor of Surgery degrees (usually Ch.B.) began to be awarded with the (M.B.), and the mastership became a higher degree, usually abbreviated Ch.M. or M.S. in London, where the first degree was M.B.,B.S..
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. Basic surgical principles for asepsis etc are known as Halsteads principles.
Modern surgery
Modern surgery developed rapidly with the scientific era. Ambroise Paré (sometimes spelled "Ambrose") 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 Abulcasis in the 10th century and improved by Ambroise Paré in the 16th century. Though this method was a significant improvement over the method of cauterization, it was still dangerous until infection risk was brought under control - at the time of its discovery, the concept of infection was not fully understood. 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 through anesthesia was discovered by two American dental surgeons, 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.
Surgical procedure
At a hospital, modern surgery is often done in an operating room using surgical instruments, an operating table for the patient, and other equipment. 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. 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). 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 patient is given a medical examination, certain pre-operative tests, and an ASA score. If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system, the patient may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before the procedure. Patients 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 patient vomits during or after the procedure.
In the pre-operative holding area, the patient changes out of his or her street clothes and is asked to confirm the details of his or her surgery. A set of vital signs are recorded, a peripheral IV line is placed, and pre-operative medications (antibiotics, sedatives, etc) are given. When the patient enters the operating room, the skin surface to be operated on is cleaned and prepared by applying an antiseptic such as chlorhexidine gluconate or povidone-iodine to reduce the possibility of infection. If hair is present at the surgical site, it is clipped off prior to prep application. Sterile drapes are used to cover all of the patient's body except for the surgical site and the patient's head; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).
Anesthesia is administered to prevent pain from incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided locally or as general 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 patient can remain conscious or minimally sedated. In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents.
An incision is made to access the surgical site. Blood vessels may be clamped 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 peritoneum. 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.
Work to correct the problem in body then proceeds. This work may involve:
excision - cutting out an organ, tumor, or other tissue.
resection - partial removal of an organ or other bodily structure.
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.
ligation - tying off blood vessels, ducts, or "tubes".
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 patient'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.
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. Sometime 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.
creation of a stoma, a permanent or semi-permanent opening in the body
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.).
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.
modifying the digestive tract in bariatric surgery for weight loss.
repair of a fistula, hernia, or prolapse
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
Surgery has also been conducted to separate conjoined twins.
Sex change operations
Blood or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped and/or reversed, and the patient is taken off ventilation and extubated (if general anesthesia was administered).
After completion of surgery, the patient is transferred to the post anesthesia care unit and closely monitored. When the patient 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 patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. 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.
Post-operative therapy may include adjuvant treatment such as chemotherapy, radiation therapy, or administration of medication such as anti-rejection medication for transplants. Other follow-up studies or rehabilitation may be prescribed during and after the recovery period.
Source and additional information: Surgery