1.
Orientation –Past , Present & Future
(History, Evolution & Scope of
Surgery)

2.
Welcome!
Dr .Muhammad Saleem Iqbal
MBBS,FCPS,FACS,FICS
Assistant Professor of Surgery
Certified Medical Teacher
Faisalabad medical university ,Faisalabad

3.
Agenda/Topics to Be Covered
• Orientation about surgery
• Past of surgery
• Present of surgery
• Future of surgery
• Summary

4.
Surgery & Surgeon !
• Surgery is an invasive technique with the fundamental principle of
physical intervention on organs/organ systems/tissues for diagnostic or
therapeutic reasons
• Surgeon: "a physician who treats diseases, injuries, and deformities by
invasive, minimally-invasive, or non-invasive surgical methods, such as
using instruments, appliances, or by manual manipulation".

5.
Why do we need to learn
history?

6.
DESIRE
To know the origin of the subject

7.
WISH
To enquire what has gone before

8.
ENTHUSIASM
To discover how current knowledge has been
derived intrinsic to learning and
understanding

9.
In study of some apparently
new problems we often make
progress by
reading work of great men of
past
CHARLES H. MAYO, 1865-
1939

10.
The patient is the centre of the medical
universe around which all our works
revolve and
towards which all our efforts trend
J.B. MURPHY, 1857-1916

11.
Ancient history

12.
The craft of surgery is as old as mankind

13.
• Drainage of abscess
• Dressing of wound
• Staunching of
hemorrhage
• Setting of fracture
• Trephination of skull
• Amputation of limb
• Circumcision

14.
Ancient East

15.
SUSHRUTA 5th
Advocated dissection of dead
bodies, practice of surgery on
watermelon,amputation,
tonsillectomy,Lithotomy, anal
fistulae, rhinoplasty

16.
Ancient Greek and
Roman

17.
Separation of medicine from magic History-
Examination- Investigation-Rx

18.
Roman
Medicine

19.
Roman surgical instruments

20.
Described cardinal signs of inflammation

21.
Figure from an
ancient text book of
surgery

22.
Works of Leonardo da
Vinci

23.
Ambroise Pare- military surgeons . He said, “I treated him; God cured
Ambrose Pare( France)--- Father of modern surgery

24.
• Thomas Gale– First ever completesurgical
Text book– 1563
• Barber-Surgeons Company was founded
in 1540 by Henry VIII
• The bodies of fourexecuted criminals
were dissected each year in Barber-
Surgeon’s Hall

25.
Henry VIII
Presents the Barber-Surgeons' Company
Charterto the first Master,

26.
• In addition to haircutting, hairdressing,
and shaving, barbers performed surgery:
neck manipulation; cleansing of earsand
scalp; draining/lancing of boils, fistulae,
and cysts with wicks; bloodletting and
leeching; fire cupping; enemas; and the
extraction of teeth.

27.
• John Hunter– apply experimental methods in
Surgery

28.
• Astley Cooper– hernia, dislocation, fracture

29.
• Joseph Lister--- Antisepsis—1867

30.
• General Anaesthesia—1846– Nitrous
oxide– 1799 .
• Inhalation anaesthesia– Ether– 1842– By an
American Medical Student.– William Clark–
tooth extraction.
• Rubber Gloves– William Halstead of Baltimore
1889
• Lister --- Operation theatre– died in 1912.
• 1932- First Intravenous anaesthesia

31.
• Theodor Billroth—”The father of
Abdominal Surgery”
• William Halsted– “Father of Breast
Surgery”
• First Hepatic Resection– Langenbuch
• Mauret--- 1987---- Lap.
Cholecystectomy.
• Parodi----1991--- Robotic surgery.

32.
Courvoisier.
He did extensive work on biliary
surgery. He originated his famous
Courvoisier’s law.

33.
Andreas Vesalius from Padua, Italy (1514 -
1564) gave the importance of human
anatomy in surgery
He gave concept of human dissection in learning anatomy and
surgery.
He wrote anatomy book ‘De Humani Coporis Fabrica Libri’.

34.
John Hunter (Glasgow, England; 1728–1793) an excellent surgeon of that
time wrote many books on surgery, war wounds.
He had outstanding collections of 13,000 specimens which were present in
the Museum of Royal College of surgeons which was destroyed during
World War II by Nazi bombing.

35.
Wilhelm Conrad Roentgen (1845–1923) invented X-
rays (1895) also called as Roentgen rays as basic
diagnostic tool. He got Nobel Prize for the same

36.
Bernard von Langenbeck (German 1810–1887) (Fig. 1-14)
did lots of contributions to surgery in technique, precision
and instruments. He did first successful cholecystectomy in
1882.

37.
Theodor Billroth (Vienna 1829–1894) (Fig. 1-15) did
extensive work in abdominal surgery. Billroth anastomosis
after gastrectomy is good old popular method.

38.
William S Halsted (America 1852–1922) (Fig. 1-13) did
extensive
work on surgeries of breast and hernia.

39.
Allen oldfather Whipple (1881–1963) (Fig. 1-16) did
successful
pancreaticoduodenectomy for pancreatic cancer in 1935.

40.
Theodor Kocher (Berne; Switzerland, August 25, 1841–1917) He was
the first surgeon to get Nobel Prize (1909)
He has written Kocher’s textbook of operative surgery in 1892.
Many surgical avenues are after his name—
Kocher’s vein;Kocher’s forceps (has got tooth in the tip); Kocherisation
(duodenal mobilisation); Kocher’s
incision (Right subcostal for open cholecystectomy);
Kocher’s thyroidectomy incision; Kocher’s test

41.
• Ambrose Pare( France)--- Father of
modern surgery
• Theodor Billroth—”The father of
Abdominal Surgery”
• William Halsted– “Father of Breast
Surgery”
• First Hepatic Resection– Langenbuch
• Mauret--- 1987---- Lap.
Cholecystectomy.

42.
Commonest Schedule surgery
• Cholecystectomy
• Mastectomy
• Hernia operations
• Hysterectomy
• Tonsillectomy
• Circumcision
• Colectomy

43.
Commonest emergency surgery
• Repair of perforation of hollow
viscus
• Appendicectomy
• Repair of injury
• Intestinal obstruction
• Caesarean section
• Abscess drainage

44.
Hospital
• Comes from the latin word” Hospices”
• Hospices means where care is providing
• Modern concept of Hospital has been
extended--- where diagnosis, treatment,
management, planning, training, teaching
and also research is ongoing.

45.
Operation
theatre

46.
Modular operation theatre

47.
Surgical procedures-- Vanishing?
• Vagotomy –
Gastrojejunostomy
• Gastrorraphy
• Nephropaxy
• Cholecystostomy
• Open prostatectomy
• Lumbar sympathectomy
• ?????????????

48.
What we have
learned?
• Surgery started before its conception
• Scientific surgery depends on scientific methods
• Evolution in surgery is a continuous process
( Roads to success is always under construction)
• Scope of surgery is tremendous

49.
What’s my (your) role in surgery?
• Learn surgery as much as possible
• Practicing surgery best of my level
• Continuous contribution in the field
• Think always how I can contribute as
our ancestor surgeon did for us.

50.
So
“Let us start to
learn Surgery
because it’s the
mankind of
future people”

51.
• Today, surgery takes a wide variety of forms and is often performed
using minimally invasive techniques. This has shortened recovery
times, improved outcomes and minimized complications for most
patients.
• To get a sense of how much surgery has changed, take a look at the
timeline of major developments in the field

52.
Birth of modern surgery
• 4 major advancements in related disciplines helped the advancement
of surgery are:
1. Knowledge of Anatomy
2. 2. Discovery of Anaesthesia
3. 3. Intraoperative haemostasis
4. 4. Concepts of asepsis

53.
Modern Surgery--20th century surgery landmarks
• improved understanding of shock
• Knowledge of blood group & blood transfusion techniques
• Understanding of blood clotting
• Development of antibiotics & analgesics
• Electrically powered surgical instruments, surgical stapling instruments, surgical glues, tapes etc.
• X-rays &scans
• Cryogenic super cooled probes
• Ultrasonic devices, Medical Lasers ,Heart lung machines, hypothermia, transplantation of organs
• Orthopaedics – cementing substances, bone & joint replacements
• Microsurgery & Minimally invasive surgery
• Vascular imaging, & Angioplasty

54.
The Technological Future of Surgery
• The future of surgery offers an amazing cooperation between humans
and technology, which could elevate the level of precision and
efficiency of surgeries so high we have never seen before

55.
1-Surgical robotics

56.
2-Virtual Reality
• VR generates an immersive,
completely artificial computer-
simulated image and
environment with real-time
interaction. VR has been used
for endoscopic training and
assessment for more than a
decade. One of the earliest
platforms was Minimally
Invasive Surgical Trainer-Virtual
Reality for endoscopic training

57.
3-Augmented reality- Advancements of Image Processing
& Vision in Healthcare
• AR is the addition of artificial information to one or more of the
senses that allows the user to perform tasks more efficiently. This
can be achieved using superimposed images, video or computer
generated models. Examples include the AccuVein, a projector-
like device that displays a map of the vasculature on the skin
surface or Google Glass (GG) which is a head mounted display
(HMD) with generated objects superimposed onto real-time
images . This technology benefited from a lightweight wearable
superimposed viewing screen and high resolution video camera
and features similar to that seen on a smartphone such as wireless
and cloud accessibility.

58.
4-Minimally Invasive Surgery
• Open cholecystectomy –four
port cholecystectomy-three
port cholecystectomy-SILS-
NOTES
• The medical device start-
up, Levita aims to refine such
procedures with its Magnetic
Surgical System. It is an
innovative technological
platform utilizing magnetic
retraction designed to grasp
and retract the gallbladder
during a laparoscopic surgery

59.
5-3D Printing and simulations in pre-
operative planning and education
• In March 2016 in China, a team of experienced doctors decided to
build a full-sized model of the heart of a small baby born with a heart
defect. Their aim was to pre-plan an extremely complicated surgery on
the tiny heart. This was the first time someone used this method in
China. The team of medical professionals successfully completed the
surgery.
• In December 2016, in the United Arab Emirates doctors have used 3D
printing technology for the first time to help safely remove a cancerous
tumour from a 42-year-old woman’s kidney.

60.
6-Live diagnostics
• With the iKnife, a mass
spectrometer analyzes the
vaporized smoke to detect the
chemicals in the biological
sample. This means it can
identify whether the tissue is
malignant real-time.
• The technology is especially
useful in detecting cancer in its
early stages and thus shifting
cancer treatment towards
prevention

61.
7-Artificial Intelligence will team up
with surgical robotics
• AI such as the deep learning
system, will soon be able to
diagnose diseases and
abnormalities. It will also give
surgeons guidance over their –
sometimes extremely – difficult
surgical decisions.

62.
Thanks
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