Surgery
A scalpel cuts through skin in 1918 at the Red Cross Hospital in Tampere, Finland. This moment captures the essence of surgery as a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions like trauma, disease, injury, or malignancy. The act involves altering bodily functions, reconstructing aesthetics, or removing unwanted tissues and foreign bodies. Most surgical procedures are invasive, requiring postoperative care for recovery from iatrogenic trauma. Modern operations typically involve a team including a surgeon, surgical assistant, anaesthetist, scrub nurse, circulating nurse, and sometimes a perfusionist if cardiopulmonary bypass is needed. Procedures can last from several minutes to tens of hours but are usually one-off interventions rather than ongoing treatments.
Elective surgery corrects non-life-threatening conditions at the person's convenience or facility availability. Semi-elective procedures should be done early to avoid complications but carry low enough risk to allow short postponement. Emergency surgery must occur without delay to prevent death, serious disability, or loss of limbs. Exploratory surgery establishes diagnoses while therapeutic surgery treats previously diagnosed conditions. Curative surgery permanently removes pathology. Plastic surgery improves function or appearance, with reconstructive plastic surgery focusing on damaged body parts. Cosmetic surgery subjectively enhances normal body parts. Bariatric surgery assists weight loss when other methods fail. Non-survival surgery performs euthanasia under anesthesia in animal testing experiments. Amputation removes entire body parts like limbs or digits. Resection removes all or part of an internal organ. Excision cuts out only part of tissue without specific vascular discrimination. Exenteration completely removes organs and soft tissue within a cavity. Extirpation surgically destroys a body part entirely. Ablation uses energy devices to destroy tissue through electrocautery, laser, ultrasound, or freezing. Repair closes injured organs by suturing or internal fixation. Reconstruction extensively repairs complex body parts using grafting or implants.
In 2012, over one-fourth of U.S. hospital stays included operating room procedures accounting for half of total hospital costs. The environment follows aseptic technique principles separating sterile from unsterile items. All instruments must be sterilized and replaced if contaminated. Staff wear sterile attire including scrubs, caps, gowns, gloves, and masks while scrubbing hands and arms for at least four minutes before each procedure. Preoperative care includes medical examinations, physical status ratings via the ASA classification system, consent forms, and surgical clearance. Autologous blood donation may occur weeks prior if significant blood loss is expected. Patients abstain from food or drink after midnight on the night before surgery to minimize aspiration risks. Some systems routinely perform chest x-rays though professional organizations recommend against routine pre-operative imaging for patients with unremarkable histories. In the operating room, hair is clipped rather than shaved. Skin surfaces are cleansed with antiseptics like chlorhexidine gluconate in alcohol which reduces infection risk twice as effectively as povidone-iodine. Sterile drapes cover operating field borders. An ether screen separates the anesthetist's unsterile area from the sterile surgical site. Anesthesia prevents pain through local, regional, or general administration. General anesthesia renders patients unconscious and paralyzed requiring intubation and mechanical ventilation.
Trepanation represents the oldest known surgical treatment dating back to the prehistoric era where holes were drilled into skulls to treat intracranial pressure issues. Ancient Egyptian mandibles dated to approximately 2650 BC show perforations indicating abscess drainage procedures. Surgical texts from ancient Egypt date back about 3500 years ago with priests performing operations using sutures and treating infections with honey. The Sushruta Samhita text from India describes numerous ailments and cosmetic surgery procedures during the first millennium BCE. Archaeologists discovered an ancient hospital building measuring 147.5 feet wide and 109.2 feet long at Alahana Pirivena in Polonnaruwa, Sri Lanka containing instruments like forceps, scissors, probes, lancets, and scalpels possibly from the 11th century AD. Galen performed audacious brain and eye surgeries in ancient Greece that were not attempted again for nearly two millennia. Ambroise Paré revolutionized battlefield medicine between 1530 and 1590 by replacing boiling oil treatments for gunshot wounds with emollients made of egg yolk, rose oil, and turpentine. John Hunter established modern scientific surgery during the Age of Enlightenment through empirical experimentation and collections of over 13,000 specimens. Anesthesia discovery began in the 1840s with ether used by American surgeon Crawford Long and chloroform developed by Scottish obstetrician James Young Simpson. Joseph Lister pioneered antiseptic techniques in the 1860s using carbolic acid sprays on instruments which dramatically reduced gangrene incidence.
Halfdan T. Mahler stated in 1980 that the vast majority of the world's population has no access whatsoever to skilled surgical care. Paul Farmer coined the term 'neglected stepchild of global health' highlighting urgent needs for further work. Jim Young Kim proclaimed in 2014 that surgery is an indispensable part of progress toward universal health coverage. The Lancet Commission on Global Surgery published a landmark report in 2015 describing how about five billion people lack access to safe and affordable surgical and anesthesia care. This gap requires 143 million additional procedures annually to prevent morbidity and mortality from treatable conditions while preventing $12.3 trillion in economic productivity losses by 2030. Poor countries account for over one-third of the global population but only 3.5% of all surgeries worldwide. Lack of adequate surgical care results in 33 million individuals facing catastrophic health expenditure exceeding 40% of household income every year. Bellwether procedures including laparotomy, caesarean section, and open fracture care represent minimum levels first-level hospitals should provide. A systematic review found cost-effectiveness ratios for surgical interventions match or exceed major public health interventions like oral rehydration therapy and HIV/AIDS antiretroviral therapy.
Surgical specialties traditionally categorize by organ system including cardiac surgery for heart vessels, thoracic surgery for lungs, gastrointestinal surgery for digestive tracts, vascular surgery for circulatory systems, urological surgery for genitourinary systems, ENT surgery for head and neck regions, neurosurgery for central nervous systems, and orthopedic surgery for musculoskeletal systems. Fetal surgery treats unborn children while pediatric surgery exclusively handles infants through adolescents. Geriatric surgery tailors treatments to older adults' specific needs. Frail elderly patients score higher on frailty scales with five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. People scoring intermediate scores are twice as likely to have post-surgical complications spending 50% more time hospitalized. Those scoring four or five face twenty times the rate of nursing home discharge compared to non-frail elderly people. Professional organizations include the World Federation of Neurosurgical Societies, American College of Surgeons, Royal Australasian College of Surgeons, and Royal College of Surgeons in England. The National Surgical Obstetric and Anesthesia Plan focuses on policy-to-action capacity building through baseline indicator analysis, local partnerships, stakeholder engagement, consensus building, language refinement, costing, dissemination, and implementation steps.
Common questions
What is surgery and when did it begin?
Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions like trauma, disease, injury, or malignancy. Trepanation represents the oldest known surgical treatment dating back to the prehistoric era where holes were drilled into skulls to treat intracranial pressure issues.
Who performs surgery and what are their roles in 1918 at the Red Cross Hospital in Tampere, Finland?
Modern operations typically involve a team including a surgeon, surgical assistant, anaesthetist, scrub nurse, circulating nurse, and sometimes a perfusionist if cardiopulmonary bypass is needed. A scalpel cuts through skin in 1918 at the Red Cross Hospital in Tampere, Finland capturing the essence of this medical practice.
When was anesthesia discovered and who developed chloroform?
Anesthesia discovery began in the 1840s with ether used by American surgeon Crawford Long and chloroform developed by Scottish obstetrician James Young Simpson. General anesthesia renders patients unconscious and paralyzed requiring intubation and mechanical ventilation during procedures.
Where does ancient Egyptian mandibles dated to approximately 2650 BC show perforations indicating abscess drainage procedures?
Ancient Egyptian mandibles dated to approximately 2650 BC show perforations indicating abscess drainage procedures. Surgical texts from ancient Egypt date back about 3500 years ago with priests performing operations using sutures and treating infections with honey.
Why do poor countries account for over one-third of the global population but only 3.5% of all surgeries worldwide?
Halfdan T. Mahler stated in 1980 that the vast majority of the world's population has no access whatsoever to skilled surgical care. The Lancet Commission on Global Surgery published a landmark report in 2015 describing how about five billion people lack access to safe and affordable surgical and anesthesia care.