A brief insight into the the history and evolution of surgery

1. SURGERY
INTRODUCTION AND HISTORICAL PERSPECTIVE
NIKHIL NANJAPPA B.A.

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4. ANCIENT SURGERY
• EARLIEST KNOWN – TREPANATION (TREPHINING)
KIEV – UKRAINE – 7300 – 6220 B.C
• ANCIENT EGYPTIAN PYRAMIDS – DISCOVERY OF
BRAIN SURGERY
• EDWIN SMITH PAPYRUS – 1600 B.C
• SUSRUTHA – 400 B.C – FATHER OF SURGERY
SUSRUTHA SAMHITHA
• ANCIENT GREEK – HIPPOCRATES & GALEN
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8. MEDIEVAL SURGERY
• DECLINE OF SURGERY IN THE WEST BY 13TH CENTURY
• PHYSICIANS HIGHER STATUS
• BARBERS & MONKS – SELF QUALIFIED SURGEONS
• ROGERIUS SALERNITANUS -1180 A.D – CHIRURGIAE
• SURGICAL THERAPY – AMPUTATIONS , DRAINAGE OF
ABSCESS,SCARIFICATION, LEECHING ETC
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12. BASIC PRINCIPLES
• 1. KNOWLEDGE OF HUMAN ANATOMY
• 2. METHOD OF CONTROLLING HEMORRHAGE AND MAINTAINING
INTRAOPERATIVE HEMOSTASIS
• 3. ANESTHESIA TO PERMIT THE PERFORMANCE OF PAIN-FREE
PROCEDURES
• 4. EXPLANATION OF THE NATURE OF INFECTION ALONG WITH THE
ELABORATION OF METHODS NECESSARY TO ACHIEVE AN ANTISEPTIC
AND ASEPTIC OPERATING ROOM ENVIRONMENT
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13. UNDERSTANDING
HUMAN ANATOMY
ANDREAS VESALIUS (1514-1564).
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14. CONTROLLING
HAEMORRHAGE
AMBROISE PARÉ (1510-1590).
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15. PATHOPHYSIOLOG
IC BASIS OF
SURGICAL
DISEASES
JOHN HUNTER (1728-1793).
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16. ANAESTHESIA
WILLIAM T. G. MORTON (1819-1868)
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17. ANTISEPSIS, ASEPSI
S, AND
UNDERSTANDING
THE NATURE OF
INFECTION
JOSEPH LISTER (1827-1912)
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18. RADIOLOGY
ESPECIALLY PROMINENT AMONG
OTHER LATE 19TH CENTURY
DISCOVERIES THAT HAD AN
ENORMOUS IMPACT ON THE
EVOLUTION OF SURGERY WAS
RESEARCH CONDUCTED BY
WILHELM ROENTGEN (1845-1923),
WHICH LED TO HIS 1895
ELUCIDATION OF X-RAYS
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19. TURN OF THE 20TH CENTURY
THEODOR BILLROTH (1829-
1894)
THEODOR KOCHER (1841-
1917)
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20. ASCENT OF
SCIENTIFIC
SURGERY
WILLIAM STEWART HALSTED (1852-
1922)
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21. INTERNATIONALIZATION, SURGICAL
SOCIETIES, AND JOURNALS
o AS THE SOPHISTICATION OF SURGERY GREW, INTERNATIONALIZATION BECAME
ONE OF ITS UNDERLYING THEMES, WITH SURGEONS CROSSING THE GREAT
OCEANS TO VISIT AND LEARN FROM ONE ANOTHER.
o HALSTED AND HERMANN KÜTTNER (1870-1932), DIRECTOR OF THE SURGICAL
CLINIC IN BRESLAU, GERMANY (NOW KNOWN AS WROCLAW AND LOCATED IN
SOUTHWESTERN POLAND), INSTITUTED THE FIRST KNOWN OFFICIAL
EXCHANGE OF SURGICAL RESIDENTS IN 1914.
o THIS EXPERIMENT IN SURGICAL EDUCATION WAS MEANT TO UNDERSCORE THE
TRUE INTERNATIONAL SPIRIT THAT HAD ENGULFED SURGERY.
o HALSTED FIRMLY BELIEVED THAT YOUNG SURGEONS ACHIEVED GREATER
CLINICAL MATURITY BY OBSERVING THE PRACTICE OF SURGERY IN OTHER
COUNTRIES, AS WELL AS IN THEIR OWN. 21

22. WORLD WAR I
ALEXIS CARREL (1873-1944)
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24. WORLD WAR 1
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27. MODERN ERA
DESPITE THE GLOBAL ECONOMIC
DEPRESSION IN THE AFTERMATH OF
WORLD WAR I, THE 1920S AND 1930S
SIGNALED THE ASCENT OF AMERICAN
SURGERY TO ITS CURRENT POSITION OF
INTERNATIONAL LEADERSHIP.
HIGHLIGHTED BY EDUCATIONAL
REFORMS IN ITS MEDICAL
SCHOOLS, HALSTED'S REDEFINITION OF
SURGICAL RESIDENCY PROGRAMS, AND
THE GROWTH OF SURGICAL
SPECIALTIES, THE STAGE WAS SET FOR
THE BLOSSOMING OF SCIENTIFIC
SURGERY. 27

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29. LAST HALF OF THE 20TH CENTURY
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30. TIMELINE

31. • 6,500 B.C.E. - SKULLS FOUND IN FRANCE SHOW SIGNS OF A RUDIMENTARY
SURGERY CALLED TREPANATION, WHICH INVOLVES DRILLING A HOLE IN
THE SKULL.
• 1540 C.E. - ENGLISH BARBERS AND SURGEONS UNITE TO FORM THE
UNITED BARBER-SURGEONS COMPANY. THESE BARBER-SURGEONS
PERFORMED TOOTH EXTRACTIONS AND BLOOD LETTING. PHYSICIANS
WERE CONSIDERED AN ENTIRELY DIFFERENT PROFESSION, TREATING
ILLNESS WITH MEDICATIONS.
• 1818 - FIRST TRANSFUSION OF HUMAN BLOOD.
• 1843 - FIRST HYSTERECTOMY PERFORMED, IN ENGLAND. 31

32. • 1843 - FIRST USE OF ETHER.
• 1846 - FIRST PUBLIC USE OF ANESTHESIA DURING SURGERY. ETHER WAS
USED. THE PATIENT WAS CONSCIOUS BUT FELT NO PAIN DURING THE
PROCEDURE TO REMOVE A TUMOR IN HIS NECK.
• 1867 - BRITISH SURGEON JOSEPH LISTER PUBLISHES ANTISEPTIC PRINCIPLE IN
THE PRACTICE OF SURGERY, EXTOLLING THE VIRTUES OF CLEANLINESS IN
SURGERY. THE MORTALITY RATE FOR SURGICAL PATIENTS IMMEDIATELY FALLS.
• 1885 - FIRST SUCCESSFUL APPENDECTOMY PERFORMED, IN IOWA.
• 1890S - WIDESPREAD USE OF CHEMICAL AGENTS TO MINIMIZE GERMS.
CARBOLIC ACID WAS PUT ON INCISIONS TO MINIMIZE GERMS AND DECREASE
INFECTION RATES.
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33. • 1893 - FIRST SUCCESSFUL HEART SURGERY PERFORMED, PROVIDENT
HOSPITAL, CHICAGO. THE SURGERY REPAIRED THE PERICARDIUM, THE SAC
AROUND THE HEART. MANY DO NOT CONSIDER THIS TO BE THE FIRST
SUCCESSFUL "HEART SURGERY" BECAUSE THE HEART ITSELF WAS NOT
OPERATED ON.
• 1895 - FIRST X-RAY PERFORMED, IN GERMANY.
• 1896 - FIRST SUCCESSFUL HEART SURGERY PERFORMED, IN GERMANY.
SURGEONS REPAIRED A STAB WOUND IN THE MUSCLE OF THE RIGHT
VENTRICLE.
• 1905 - FIRST SUCCESSFUL CORNEA TRANSPLANT.
• 1917 - FIRST DOCUMENTED PLASTIC SURGERY PERFORMED, ON A BURNED
ENGLISH SAILOR.
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34. • 1922 - INSULIN FIRST USED FOR TREATMENT OF DIABETES, ALLOWING
DIABETICS TO SURVIVE AFTER DIAGNOSIS.
• 1928 - ANTIBIOTICS DISCOVERED.
• 1930 - GERMAN MAN HAS THE FIRST SEX CHANGE OPERATION (TO A
FEMALE).
• 1937 - FIRST BLOOD BANK OPENS, HELPING MAKE MORE SURGERY
POSSIBLE BY TREATING BLEEDING DURING THE PROCEDURE.
• 1940 - FIRST METAL HIP REPLACEMENT SURGERY PERFORMED. 34

35. • 1950S - FIRST LASIK EYE PROCEDURES PERFORMED, IN COLUMBIA.
• 1950 - FIRST SUCCESSFUL ORGAN TRANSPLANT. THE KIDNEY RECIPIENT
REJECTED THE ORGAN AFTER EIGHT MONTHS.
• 1952 - FIRST SUCCESSFUL HEART SURGERY WHERE THE HEART WAS STOPPED
AND RESTARTED.
• 1953 - FIRST SUCCESSFUL SURGERY USING A HEART-LUNG BYPASS MACHINE.
• 1954 - FIRST SUCCESSFUL LIVING DONOR KIDNEY TRANSPLANT, THE KIDNEY
WAS DONATED BY THE RECIPIENT'S TWIN BROTHER. THE RECIPIENT LIVED
EIGHT YEARS AFTER THE PROCEDURE.
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36. • 1966 - FIRST SUCCESSFUL PANCREAS TRANSPLANT.
• 1967 - FIRST SUCCESSFUL LIVER TRANSPLANT.
• 1967 - FIRST HEART TRANSPLANT SURGERY PERFORMED, BY SOUTH
AFRICAN CHRISTIAN BARNARD. THE HEART RECIPIENT SURVIVED 18 DAYS
UNTIL SUCCUMBING TO PNEUMONIA.
• 1975 - FIRST ORGAN SURGERY PERFORMED USING LAPAROSCOPIC, OR
MINIMALLY INVASIVE, TECHNIQUE.
• 1978 - FIRST "TEST TUBE" BABY BORN.
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37. • 1982 - JARVIK-7 ARTIFICIAL HEART USED.
• 1984 - BABY FAE SURVIVES 21 DAYS AFTER BEING TRANSPLANTED WITH
THE HEART OF A BABOON.
• 1985 - FIRST DOCUMENTED ROBOTIC SURGERY.
• 1999 - FIRST SUCCESSFUL HAND TRANSPLANT (PREVIOUS PATIENTS HAD
REJECTED THEIR GRAFTS).
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38. • 2000 - DA VINCI ROBOTIC SURGICAL SYSTEM WINS U.S. FOOD AND DRUG
ADMINISTRATION APPROVAL. THE SYSTEM IS NOW USED IN A WIDE
VARIETY OF PROCEDURES, INCLUDING PROSTATE SURGERIES AND
CORONARY ARTERY BYPASS.
• 2007 - FIRST NATURAL ORIFICE TRANSLUMENAL ENDOSCOPIC SURGERY
PERFORMED. THIS TECHNIQUE USES A NATURAL BODY OPENING, SUCH AS
THE MOUTH, TO INSERT INSTRUMENTS AND MINIMIZE RECOVERY TIMES.
• 2010 - WORLD'S FIRST FULL-FACE TRANSPLANT PERFORMED, IN SPAIN.
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44. SURGEONISMS
• 1.ALL BLEEDING EVENTUALLY STOPS.
• 2.A VERY BOLD SURGEON IS ONE WHO REALISES
THAT HIS PATIENT TAKES ALL THE RISKS.
• 3. IT TAKES 5 YEARS TO KNOW WHEN TO
OPERATE, AND 20 YEARS TO LEARN WHEN NOT TO
• 4.THERE ARE ONLY 3 RULES TO A SURGEON'S LIFE :
EAT WHEN U CAN, SLEEP WHEN U CAN AND DON'T
SCREW WITH THE PANCREAS
• 5.DON'T LOOK FOR THINGS YOU DON'T WANT TO FIND
• 6.WHEN IN DOUBT,BLAME THE ANESTHETIST.
• 7.THE LESSER THE INDICATION, THE GREATER WILL
BE THE COMPLICATION
• 8.SURGERY, LIKE MAKING LOVE, SHOULD BE DONE
GENTLY WITH ADEQUATE EXPOSURE..
• 9. IT IS BETTER TO BE LUCKY THAN GOOD...
• 10. PYAR AUR SURGEON KABHI ZUKTA NAHI....
• 11. NEVER RELY ON INVESTIGATIONS ... ITS ALWAYS
BETTER TO
• ' OPEN & SEE '.
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