Surgical is the medical specialty that deals with cutting, shaping and removal of tissue to treat diseases or injuries. It is a highly specialized area of medicine that has evolved from superstition to science over the centuries.
Surgery can be minor, which means it doesn’t involve opening a large part of your body or touching your major organs. It can be done in a hospital or doctor’s office and is usually quick. Click Here to learn more.
Throughout the centuries, surgical science progressed from superstition to scientific footing. From the 16th-century saga of Andreas Vesalius, who risked his life in an effort to accurately describe human anatomy, to surgeons’ apathy toward Joseph Lister’s innovation of antisepsis, this book chronicles how surgery evolved from bloodletting and trephination (in which holes were drilled into skulls to free illness, spirits and demons) to the surgical innovations that are so much a part of today’s medicine.
This book is a quick read that will appeal to those who have a general interest in medical history and the evolution of the discipline of surgery. However, readers who want more depth would be better served by a book that focuses on a specific time period or location or surgeon.
For example, a book on the history of Indian surgery (circa 400 BC) outlines many surgical procedures including skin grafts and reconstructing body parts that were lost to amputations, trephination, and the judicial practice of burning or removing parts of the nose and ears as punishment. It was also during this era that the first rudimentary dental instruments were developed and anesthesia came into use.
In the Middle Ages, a separation began to form between medicine and surgery as barber-surgeons traveled around performing minor procedures such as tooth extraction, bloodletting, and war wound care. This trend continued until the 1700s when surgery became a part of university-based education and training.
In the 19th century, surgeons started washing their hands as Pasteur discovered bacteria and Lister introduced the concept of asepsis (infection control). This was the final shift that allowed for more successful surgeries. The next step was the introduction of anesthesia and the use of clean linens dressed beds and operating tables. This helped surgeons to become more accurate, thorough, and precise. This also created role models and teachers that students could look up to and emulate. This is the era that produced Harvey Williams Cushing and Walter Dandy who were pioneers in neurosurgery. In the 20th century, US surgeons led the world in transplantation and artificial hearts as well as many other medical advancements.
Techniques
Surgeons must have a range of surgical techniques in their toolkit. They need to be able to use traditional tools such as knives (scalpels), but they must also have ways to cope with situations that require new and more sophisticated technologies. For example, laser surgery can be used to cut tissue while sparing nearby healthy cells. This can be useful in removing tumors, reshaping tissues or treating other conditions such as gynecological diseases or skin problems such as scars and tattoos.
A surgeon must be able to select the most appropriate technique and anesthetic for a particular patient, taking into account the type of disease and the stage at which it is being treated. The choice must be made with the aim of solving the problem as quickly and safely as possible. This will minimise the time needed for recovery, reduce the risk of complications and limit the stress response from the operation.
In addition to using a variety of tools and techniques, surgeons must be able to apply a systematic approach to patient management. This includes defining the diagnosis, establishing a plan of treatment and explaining it to the patient. It is also important for the surgeon to maintain a high standard of ethical behaviour and to keep up-to-date with the latest advances in surgical technology.
The adoption of a scientific methodology and the development of aseptic techniques were major milestones in the history of surgery. These improvements were based on the discovery that the main cause of infection in surgical wounds was bacteria and the introduction of the steam sterilizer, rigorous hand washing and the wearing of disposable gloves all contributed to the rise of sterile surgery.
Laparoscopic and endoscopic techniques have been the major turning point in surgery and have enabled procedures that required major trauma to be converted into minimally invasive surgeries. But, these techniques have taken a toll on the surgeon’s ability to feel a part of the surgery and many surgical skills are being lost. Future technology is likely to lead to even less invasive and noninvasive modalities.
Instruments
The tools used during surgery are vast and varied. Each has a specific purpose for the surgeon to achieve during a procedure. A surgeon may use them to manipulate, retraction, cut and suction within the surgical field (the area being operated on). Some of these instruments are disposable such as scalpels while others are reusable like knife blades. The choice of an instrument depends on the type of surgery being performed, the surgeon’s preference and the anatomy being operated on.
The first basic tool used by a surgeon is the scalpel, a small knife that makes cuts in tissue, muscle and bone. The blades of the scalpel come in different sizes for various operations. For example, a vascular surgeon would utilize a blade of a certain size for cutting blood vessels while gynecologists and obstetricians prefer the use of smaller, more precise scissors for cutting ligaments.
Forceps are another common surgical tool that grasp and hold tissue, blood vessels or organs during a surgery. They vary in their design and size as well. For example, some have a serrated surface while others are smooth. The most common type of forceps is the rat toothed forceps used to hold skin, Babcock forceps for grasping intestine or towels and Allis forceps for holding tissues or bone.
Retractors are used to help the surgeon view the surgical site more clearly by securing or moving tissues out of the way. These can be handheld or self-retaining. Some of these instruments are disposable while others are reusable and include retractors for bowels, laparotomies, rectals, urology and vascular procedures.
Surgical instruments that are not properly sterilized and disinfected after each use introduce pathogens into the patient’s body, potentially leading to infection. This is due to the breach of host barriers caused by unsterilized instruments that carry bacteria, saliva, blood and foreign material from previous patients.
Properly caring for surgical instruments during and after a procedure creates a partnership between surgical teams and sterile processing technicians. It keeps the OR running smoothly, saves money by extending the life of instrument sets and ultimately reduces the risk of surgical site infections.
Procedures
The procedures used in surgery may be designed to remove an abscess, cancer or other malignancy; to open blockages in arteries and veins that do not receive enough blood flow; to reconstruct tissue damaged by injury, illness or disease; or to alter bodily function (such as a cleft palate repair). Some surgical operations are designed to enhance cosmetic appearance.
The goal of all surgeries is to provide the best possible result and to prevent complications from occurring. Anesthesia is administered to prevent pain from the cutting, manipulation and application of thermal energy involved in the procedure. Anesthesia is given by injection, spinal cord block or general anesthesia.
During an operation, a person is sedated or unconscious and protected from the elements by means of sterile drapes, masks that filter exhaled air and sterilized gowns. To ensure asepsis, the freedom of a surgical field from contamination with pathogenic organisms, all instruments and dry goods that touch the area to be operated on are sterilized by placing them in an autoclave, which subjects them to high-pressure steam for a period of time. In addition, members of the surgical team scrub their hands with antiseptic soap and use chemical disinfectants.
When the surgeon is ready to begin an operation, he or she makes an incision at the surgical site. This incision can be made from the front of the body or through a passage in a hollow organ. For some procedures, the incision can be made by using a tube equipped with a light and a video connection, called an endoscope.
After an incision is made, the surgeon identifies and separates tissues to be removed from those that are not to be touched. The surgeon also cuts or breaks blood vessels to prevent bleeding during the operation and sews together any tissues that have been joined together. A patient undergoing a surgical procedure is generally given antibiotics to prevent infection. After an operation, the surgeon inspects the wound and the surrounding area to make sure that the operation has been successful. If it has not, reoperation or revision may be needed.