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Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas. The act of performing surgery may be called a surgical procedure, operation, or simply "surgery". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g.
surgical instrument A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...
s or
surgical nurse A surgical nurse, also referred to as a theatre nurse or scrub nurse, specializes in perioperative care, providing care to patients before, during and after surgery. To become a theatre nurse, Registered Nurses or Enrolled Nurses must complete ex ...
. The person or subject on which the surgery is performed can be a person or an animal. A
surgeon In modern medicine, a surgeon is a physician who performs surgery. There are also surgeons in podiatry, dentistry, orthodontics, and veterinary medicine. History The first person to document a surgery was the 6th century BC Indian physician-sur ...

surgeon
is a person who practices surgery and a
surgeon's assistantAn assistant surgeon, assistant in surgery, physicians as assistants at surgery, surgeon assistant, first assistant or surgical assistant assists with a surgical operation under the direction of a surgeon. In the United Kingdom, a surgical care prac ...
is a person who practices surgical assistance. A
surgical team Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or tre ...
is made up of the surgeon, the
surgeon's assistantAn assistant surgeon, assistant in surgery, physicians as assistants at surgery, surgeon assistant, first assistant or surgical assistant assists with a surgical operation under the direction of a surgeon. In the United Kingdom, a surgical care prac ...
, an anaesthetist, a circulating nurse and a
surgical technologist A surgical technologist, also called a scrub, scrub tech, surgical technician, or operating room technician, is an allied health professional working as a part of the team delivering surgical care. Surgical technologists are members of the surgical ...
. Surgery usually spans from minutes to hours, but it is typically not an ongoing or periodic type of treatment. The term "surgery" can also refer to the place where surgery is performed, or, in British English, simply the office of a
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a professional who practices medicine, which is concerned with promoting, maintaining, or restoring health through the study, dia ...
,
dentist A dentist, also known as a dental surgeon, is a medical professional who specializes in dentistry, the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aids in providing oral healt ...
, or
veterinarian A veterinarian (vet), also known as a veterinary surgeon or veterinary physician, is a professional who practices veterinary medicine by treating diseases, disorders, and injuries in non-human animals. Description In many countries, the local ...
.


Definitions

Surgery is an invasive technique with the fundamental principle of physical intervention on organs/organ systems/tissues for diagnostic or therapeutic reasons. As a general rule, a procedure is considered surgical when it involves cutting of a person's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as
angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A ...
or
endoscopy An endoscopy (''looking inside'') is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, en ...
, may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment,
anesthesia Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia (relief from or prevention of pain), par ...
,
antiseptic Antiseptics (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antisept ...
conditions, typical
surgical instruments A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...
, and
suturing Surgical suture is a medical device used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been ...
or
stapling A staple is a type of two-pronged fastener, usually metal, used for joining or binding materials together. Large staples might be used with a hammer or staple gun for masonry, roofing, corrugated boxes and other heavy-duty uses. Smaller staples a ...
. 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).


Types of surgery

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation. * Based on timing:
Elective surgery Elective surgery or elective procedure (from the la, eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's ...
is done to correct a non-life-threatening condition, and is carried out at the person's request, subject to the surgeon's and the surgical facility's availability. A
semi-elective surgery Elective surgery or elective procedure (from the la, eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's ...
is one that must be done to avoid permanent disability or death, but can be postponed for a short time.
Emergency surgery Elective surgery or elective procedure (from the la, eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's ...
is surgery which must be done without any delay to prevent death or serious disabilties and/or loss of limbs and functions. * Based on purpose:
Exploratory surgery Exploratory surgery is a diagnostic method used by doctors when trying to find a diagnosis for an ailment. With the invention of modern imaging techniques, exploratory surgery is becoming less common in humans. Due to the high cost and lower availa ...
is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition.
Cosmetic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofacia ...
is done to subjectively improve the appearance of an otherwise normal structure. * By type of procedure:
Amputation Amputation is the removal of a limb by trauma, medical illness, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals ...
involves cutting off a body part, usually a limb or digit; castration is also an example. Resection is the removal of all of an internal organ or body part, or a key part (lung lobe; liver quadrant) of such an organ or body part that has its own name or code designation. A
segmental resectionSegmental resection (or segmentectomy) is a surgical procedure to remove part of an organ or gland, as a sub-type of a resection, which might involve removing the whole body part. It may also be used to remove a tumor and normal tissue around it. In ...
can be of a smaller region of an organ such as a hepatic segment or a
bronchopulmonary segment A bronchopulmonary segment is a portion of lung supplied by a specific segmental bronchus and its vessels. These arteries branch from the pulmonary and bronchial arteries, and run together through the center of the segment. Veins and lymphatic vesse ...
. Excision is the cutting out or removal of only part of an organ, tissue, or other body part from the person. Extirpation is the complete excision or surgical destruction of a body part.
Replantation Replantation or reattachment has been defined by the American Academy of Orthopaedic Surgeons as "the surgical reattachment of a body part (such as a finger, hand, or toe) that has been completely cut from the body." Examples would be reattachment ...
involves reattaching a severed body part.
Reconstructive surgery Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with plastic surgery. In regard to training, Plastic Surgery is a recognized medical specialty and a surgeon ...
involves reconstruction of an injured, mutilated, or deformed part of the body. Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the person undergoing surgery. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery. * By body part: When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones or muscles). * By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer incisions to insert miniaturized instruments within a body cavity or structure, as in
laparoscopic surgery Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medline ...
or
angioplasty Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A ...
. By contrast, an open surgical procedure such as a
laparotomy A laparotomy is a surgical procedure involving small incisions through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. Origins and history The first successful laparotomy was performed without anesthesi ...
requires a large incision to access the area of interest. * By equipment used:
Laser surgery Laser surgery is a type of surgery that uses a laser (in contrast to using a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft-tissue laser surgery, in which the laser beam vaporizes ...
involves use of a
laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The term "laser" originated as an acronym for "light amplification by stimulated emission of radia ...

laser
for cutting tissue instead of a
scalpel A scalpel, or lancet, or bistoury, is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (called a hobby knife). Scalpels may be single-use disposable or re-usable. Re-usabl ...
or similar surgical instruments.
Microsurgery Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which ...
involves the use of an operating
microscope A microscope (from the grc, μικρός, ''mikrós'', "small" and , ''skopeîn'', "to look" or "see") is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigati ...
for the surgeon to see small structures.
Robotic surgery Robotic surgery are types of surgical procedures that are done using robotic systems. Robotically-assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilit ...
makes use of a surgical
robot A robot is a machine—especially one programmable by a computer— capable of carrying out a complex series of actions automatically. Robots can be guided by an external control device or the control may be embedded within. Robots may be cons ...
, such as the
Da Vinci Leonardo da Vinci (15 April 14522 May 1519) was an Italian polymath of the High Renaissance who was active as a painter, sculptor, architect, draughtsman, theorist, engineer and scientist. While his fame initially rested on his achievements ...
or the
ZEUS robotic surgical system The ZEUS Robotic Surgical System (ZRSS) was a medical robot designed to assist in surgery, originally produced by the American robotics company Computer Motion. Its predecessor, AESOP, was cleared by the Food and Drug Administration in 1994 to assi ...
s, to control the instrumentation under the direction of the surgeon.


Terminology

* Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy. * Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the
abdominal The abdomen (colloquially called the belly, tummy, midriff or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the trunk. The area ...
wall to gain access to the
abdominal cavity The abdominal cavity is a large body cavity in humans and many other animals that contains many organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the tho ...
is a
laparotomy A laparotomy is a surgical procedure involving small incisions through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. Origins and history The first successful laparotomy was performed without anesthesi ...
. *
Minimally invasive procedures Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed and so lessen wound healing time, associated pain and risk of infection. Surgery by definition is inv ...
, involving small incisions through which an endoscope is inserted, end in -oscopy. For example, such surgery in the abdominal cavity is called
laparoscopy Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medline ...
. * Procedures for formation of a permanent or semi-permanent opening called a
stoma In botany, a stoma (from Greek ''στόμα'', "mouth", plural "stomata"), also called a stomate (plural "stomates") is a pore, found in the epidermis of leaves, stems, and other organs, that controls the rate of gas exchange. The pore is bord ...
in the body end in -ostomy. * Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in -oplasty. ''Rhino'' is used as a prefix for "nose", therefore a ''
rhinoplasty Rhinoplasty ( , nose + , to shape), commonly known as a nose job, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions ...

rhinoplasty
'' is reconstructive or cosmetic surgery for the nose. * Repair of damaged or congenital abnormal structure ends in -rraphy. * Reoperation (return to the operating room) refers to a return to the operating theater after an initial surgery is performed to re-address an aspect of patient care best treated surgically. Reasons for reoperation include persistent bleeding after surgery, development of or persistence of infection.


Description of surgical procedure


Location

Inpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, psychologist, dentist, veterinarian, or other health care p ...
surgery is performed in a hospital, and the person undergoing surgery stays at least one night in the hospital after the surgery.
Outpatient surgery Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay.The International Association for Ambulatory Surgery (IAAS) would not consider all ...
occurs in a hospital outpatient department or freestanding ambulatory surgery center, and the person who had surgery is discharged the same working day. Office surgery occurs in a physician's office, and the person is discharged the same working day. At a
hospital A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat ...

hospital
, modern surgery is often performed in an
operating theater An operating theater (also known as an operating room (OR), operating suite, or operation suite) is a facility within a hospital where surgical operations are carried out in an aseptic environment. Historically, the term "operating theatre" refer ...
using
surgical instrument A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...
s, an
operating table Operation or Operations may refer to: Science and technology * Surgical operation or surgery, in medicine * Operation (mathematics), a calculation from zero or more input values (called operands) to an output value ** Arity, number of arguments or ...
, and other equipment. Among United States hospitalizations for nonmaternal and nonneonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures. The environment and procedures used in surgery are governed by the principles of
aseptic technique Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is derived ...
: 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.


Preoperative care

Prior to surgery, the person is given a
medical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient' ...
, receives certain pre-operative tests, and their physical status is rated according to the
ASA physical status classification system The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category ...
. If these results are satisfactory, the person requiring surgery signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an
autologous Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person (''auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogeneic, or ...
blood donation A blood donation occurs when a person voluntarily has blood drawn and used for transfusions and/or made into biopharmaceutical medications by a process called fractionation (separation of whole blood components). Donation may be of whole blood, ...
may be made some weeks prior to surgery. If the surgery involves the
digestive system The human digestive system consists of the gastrointestinal tract plus the accessory organs of digestion (the tongue, salivary glands, pancreas, liver, and gallbladder). Digestion involves the breakdown of food into smaller and smaller component ...
, the person requiring surgery may be instructed to perform a bowel prep by drinking a solution of
polyethylene glycol Polyethylene glycol (PEG; ) is a polyether compound derived from petroleum with many applications, from industrial manufacturing to medicine. PEG is also known as polyethylene oxide (PEO) or polyoxyethylene (POE), depending on its molecular wei ...
the night before the procedure. People preparing for surgery 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 person vomits during or after the procedure. Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly., citing * Last reviewed 2011. * * * * * * However,
medical specialty A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care (famil ...
professional organizations A professional association (also called a professional body, professional organization, or professional society) seeks to further a particular profession, the interests of individuals engaged in that profession and the public interest. In the Un ...
recommend against routine pre-operative
chest x-rays A chest radiograph, called a chest X-ray (CXR), or chest film, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures. Chest radiographs are the most common film taken in medic ...
for people who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray. Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the person. Likewise, other tests including
complete blood count A complete blood count (CBC), also known as a full blood count (FBC), is a set of medical laboratory tests that provide information about the cells in a person's blood. The CBC indicates the counts of white blood cells, red blood cells and platel ...
,
prothrombin time The prothrombin time (PT) – along with its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) – are assays evaluating the ''extrinsic'' pathway and common pathway of coagulation. This blood test is also called ...
,
partial thromboplastin time The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a blood test that characterizes coagulation of the blood. A historical name for this measure is the kaolin-cephalin clotting time (KCCT), reflecting k ...
,
basic metabolic panel A basic metabolic panel (BMP) is a blood test consisting of a set of seven or eight biochemical tests and is one of the most common lab tests ordered by health care providers. Outside the United States, blood tests made up of the majority of the s ...
, and
urinalysis Clinical urine tests are examinations of the physical and chemical properties of urine and its microscopic appearance to aid in medical diagnosis. The term urinalysis—a blend of the words ''urine'' and ''analysis''—generally refers to the gross ...
should not be done unless the results of these tests can help evaluate surgical risk., which cites #* #* #* #* #*


Staging for surgery

The pre-operative holding area is so important in the surgical phase since here is where most of the family members can see who the staff of the surgery will be, also this area is where the nurses in charge to give information to the family members of the patient. In the pre-operative holding area, the person preparing for surgery 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 person enters the operating room, the skin surface to be operated on, called the operating field, is cleaned and prepared by applying an
antiseptic Antiseptics (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antisept ...
(ideally
chlorhexidine gluconate Chlorhexidine (commonly known by the salt forms chlorhexidine gluconate and chlorhexidine digluconate (CHG) or chlorhexidine acetate), is a disinfectant and antiseptic that is used for skin disinfection before surgery and to sterilize surgical in ...
in alcoholic, as this is twice as effective as
povidone-iodine Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may al ...
for reduce the risk of infection. If hair is present at the surgical site, it is clipped off prior to prep application. The person is assisted by an anesthesiologist or resident to make a specific surgical position, then sterile drapes are used to cover the surgical site or at least a wide area surrounding the operating field; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the
anesthetist Anesthesiology is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician spec ...
/
anesthesiologist Anesthesiology is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician spec ...

anesthesiologist
's working area (unsterile) from the surgical site (sterile).
Anesthesia Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia (relief from or prevention of pain), par ...
is administered to prevent
pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ac ...
from an incision, tissue manipulation and suturing. Depending on the kind of operation, anesthesia may be provided
locallyIn mathematics, a mathematical object is said to satisfy a property locally, if the property is satisfied on some limited, immediate portions of the object (e.g., on some ''sufficiently small'' or ''arbitrarily small'' neighborhoods of points). Prop ...
or as
general anesthesia General anaesthesia or general anesthesia (see spelling differences) is a medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anaesthetic agents. It is carried out to allow medical proc ...
.
Spinal anesthesia Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarach ...
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 person can remain conscious or minimally sedated. In contrast, general anesthesia renders the person unconscious and paralyzed during surgery. The person is
intubated Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blakemore t ...
and is placed on a
mechanical ventilator A ventilator is a machine that provides mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators are computerized micr ...
, and anesthesia is produced by a combination of injected and inhaled agents. Choice of surgical method and
anesthetic An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two br ...
technique aims to reduce the risk of complications, shorten the time needed for recovery and minimise the
surgical stressSurgical stress is the systemic response to surgical injury and is characterized by activation of the sympathetic nervous system, endocrine responses as well as immunological and haematological changes. Measurement of surgical stress is used in anaes ...
response.


Intraoperative phase

The intraoperative phase begins when the surgery subject is received in the surgical area (such as the
operating theater An operating theater (also known as an operating room (OR), operating suite, or operation suite) is a facility within a hospital where surgical operations are carried out in an aseptic environment. Historically, the term "operating theatre" refer ...
or surgical department), and lasts until the subject is transferred to a recovery area (such as a
post-anesthesia care unit A post-anesthesia care unit, often abbreviated PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery is a vital part of hospitals, ambulatory care centers, and other medical facilities. It is an area, normally att ...
). An incision is made to access the surgical site.
Blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away fr ...
s may be clamped or cauterized 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 the peritoneum. In certain cases,
bone A bone is a rigid tissue that constitutes part of the vertebrate skeleton in animals. Bones protect the various organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, and enable mobili ...
may be cut to further access the interior of the body; for example, cutting the
skull The skull is a bone structure that forms the head in vertebrates. It supports the structures of the face and provides a protective cavity for the brain. The skull is composed of two parts: the cranium and the mandible. In humans, these two parts ...

skull
for
brain A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a verte ...
surgery or cutting the
sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Shaped ...
for thoracic (chest) surgery to open up the
rib cage The rib cage is the arrangement of ribs attached to the vertebral column and sternum in the thorax of most vertebrates, that encloses and protects the vital organs such as the heart, lungs and great vessels. In humans, the rib cage and the sternu ...
. Whilst in surgery
aseptic technique Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is derived ...
is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands. An antiseptic solution is applied to the area of the person's body that will be operated on. Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. 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 Surgical suture is a medical device used to hold body tissues together after an injury or surgery. Application generally involves using a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been ...

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. * reduction – the movement or realignment of a body part to its normal position. e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics. * Ligature (medicine), ligation – tying off blood vessels, ducts, or "tubes". * Medical grafting, 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 person's body and inserted to another area of the body. An example is Vascular bypass, 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 Prosthesis, 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. Sometimes a plate is inserted to replace a damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or Heart valve, valves may be inserted. Many other types of Prosthesis, prostheses are used. * creation of a stoma (medicine), stoma, a permanent or semi-permanent opening in the body * in Organ transplant, 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. * repair according to the ICD-10-PCS, in the Medical and Surgical Section 0, root operation Q, means restoring, to the extent possible, a body part to its normal anatomic structure and function. This definition, repair, is used only when the method used to accomplish the repair is not one of the other root operations. Examples would be colostomy takedown, herniorrhaphy of a hernia, and the surgical suture of a laceration. * 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 Blood transfusion, Blood or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete, surgical suture, sutures or Surgical staple, staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the person is taken off ventilation and wikt:extubate, extubated (if general anesthesia was administered).Askitopoulou, H., Konsolaki, E., Ramoutsaki, I., Anastassaki, E. ''Surgical cures by sleep induction as the Asclepieion of Epidaurus.'' The history of anesthesia: proceedings of the Fifth International Symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V., International Congress Series 1242(2002), pp. 11–17

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Postoperative care

After completion of surgery, the person is transferred to the post anesthesia care unit and closely monitored. When the person 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 person's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with postoperative complications, such as immune deficiency and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications. 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. It is not uncommon for surgical drains (see Drain (surgery)) to be required to remove blood or fluid from the surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading to abscess. Postoperative 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 Physical therapy, rehabilitation may be prescribed during and after the recovery period. The use of Antibacterial, topical antibiotics on surgical wounds to reduce infection rates has been questioned., which cites * Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developing contact dermatitis and antibiotic resistance. It has also been suggested that topical antibiotics should only be used when a person shows signs of infection and not as a preventative. A systematic review published by Cochrane (organisation) in 2016, though, concluded that topical antibiotics applied over certain types of surgical wounds reduce the risk of surgical site infections, when compared to no treatment or use of
antiseptic Antiseptics (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antisept ...
s. The review also did not find conclusive evidence to suggest that topical antibiotics increased the risk of local skin reactions or antibiotic resistance. Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. This "weekday effect" has been postulated to be from several factors including poorer availability of services on a weekend, and also, decrease number and level of experience over a weekend. While pain is universal and expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines. Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities. Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge.


Epidemiology


United States

In 2011, of the 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $387 billion in hospital costs. The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals. Data from 2003 to 2011 showed that U.S. hospital costs were highest for the surgical service line; the surgical service line costs were $17,600 in 2003 and projected to be $22,500 in 2013. For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure. in 2012, mean hospital costs in the United States were highest for surgical stays.


Special populations


Elderly people

Older adults have widely varying physical health. Frailty syndrome, Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Assessment of older people before elective surgery can accurately predict the person's recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. People who are frail and elderly (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.


Children

Surgery on children requires considerations that are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments. Bariatric Surgery#Bariatric Surgery in Youth, Bariatric surgery in youth is among the controversial topics related to surgery in children.


Vulnerable populations

Doctors perform surgery with the consent of the person undergoing surgery. Some people are able to give better informed consent than others. Populations such as Incarceration, incarcerated persons, dementia, people living with dementia, the mentally incompetent, persons subject to coercion, and other people who are not able to make decisions with the same authority as others, have special needs when making decisions about their personal healthcare, including surgery.


'Global Surgery' in low- and middle-income countries

Surgery remains grossly neglected in global health, famously described by Halfdan T. Mahler as the 'neglected stepchild of global health'. This particularly affects low-resource settings with weak surgical health systems. 'Global surgery' is the term now adopted to describe the rapidly developing field seeking to address this, and has been defined as 'the multidisciplinary enterprise of providing improved and equitable surgical care to the world's population, with its core tenets as the issues of need, access and quality'. In 2014, The Lancet Commission on Global Surgery was launched to examine the case for surgery as an integral component of global health care and to provide recommendations regarding the delivery of surgical and anesthesia services in low and middle income countries. In this study, two primary conclusions were reached: * Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. Areas in which especially large proportions of the population lack access include Sub-Saharan Africa, the Indian Subcontinent, Central Asia and, to a lesser extent, Russia and China. Of the estimated 312.9 million surgical procedures undertaken worldwide in 2012, only 6.3% were done in countries comprising the poorest 37.3% of the world's population. * An additional 143 million surgical procedures are needed each year to prevent unnecessary death and disability. Globally, 4.2 million people are estimated to die within 30 days of surgery each year, with half of these occurring in low- and middle-income countries. A prospective study of 10,745 adults undergoing emergency abdominal surgery from 357 centres across 58 countries found that mortality is three times higher in low- compared with high-human development index (HDI) countries even when adjusted for prognostic factors. In this study the overall global mortality rate was 1·6 per cent at 24 hours (high HDI 1·1 per cent, middle HDI 1·9 per cent, low HDI 3·4 per cent), increasing to 5·4 per cent by 30 days (high HDI 4·5 per cent, middle HDI 6·0 per cent, low HDI 8·6 per cent; P < 0·001). A sub-study of 1,409 children undergoing emergency abdominal surgery from 253 centres across 43 countries found that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. This translates to 40 excess deaths per 1000 procedures performed in these settings. Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days. Introducing novel or new surgical techniques in low- and middle-income countries is a challenge. Challenges include knowledge (awareness), fear, costs, and cultural beliefs.


Human rights

Access to surgical care is increasingly recognized as an integral aspect of healthcare, and therefore is evolving into a normative derivation of human right to health. The ICESCR Article 12.1 and 12.2 define the human right to health as "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" In the August 2000, the UN Committee on Economic, Social and Cultural Rights (CESCR) interpreted this to mean "right to the enjoyment of a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable health".UN Committee on Economic Social and Cultural Rights. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12) 2000 Surgical care can be thereby viewed as a positive right – an entitlement to protective healthcare. Woven through the International Human and Health Rights literature is the right to be free from surgical disease. The 1966 ICESCR Article 12.2a described the need for "provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child" which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services". Article 12.2d of the ICESCR stipulates the need for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness", and is interpreted in the 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment of injury and disability.".UN Committee on Economic Social and Cultural Rights. CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12) 2000. Obstetric care shares close ties with reproductive rights, which includes access to reproductive health. Surgeons and public health advocates, such as Kelly McQueen, have described surgery as "Integral to the right to health". This is reflected in the establishment of the WHO Global Initiative for Emergency and Essential Surgical Care in 2005, the 2013 formation of the Lancet Commission for Global Surgery, the 2015 World Bank Publication of Volume 1 of its Disease Control Priorities "Essential Surgery", and the 2015 World Health Assembly 68.15 passing of the Resolution for Strengthening Emergency and Essential Surgical Care and
Anesthesia Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia (relief from or prevention of pain), par ...
as a Component of Universal Health Coverage. The Lancet Commission for Global Surgery outlined the need for access to "available, affordable, timely and safe" surgical and anesthesia care; dimensions paralleled in ICESCR General Comment No. 14, which similarly outlines need for available, accessible, affordable and timely healthcare.


History

, an Egyptian surgical treatise


Trepanation

Surgical treatments date back to the prehistoric era. The oldest for which there is evidence is trepanation, in which a hole is drilled or scraped into the Human skull, skull, thus exposing the dura mater in order to treat health problems related to intracranial pressure and other diseases.


Ancient Egypt

Prehistoric surgical techniques are seen in Ancient Egypt, where a Human mandible, mandible dated to approximately 2650 BC shows two perforations just below the root of the first molar (tooth), molar, indicating the draining of an Tooth abscess, abscessed tooth. Surgical texts from ancient Egypt date back about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today, and used sutures to close wounds. Infections were treated with honey.


India

Remains from the early Indus Valley Civilization, Harappan periods of the Indus Valley Civilization (c. 3300 BC) show evidence of teeth having been drilled dating back 9,000 years. Susruta was an ancient Indian
surgeon In modern medicine, a surgeon is a physician who performs surgery. There are also surgeons in podiatry, dentistry, orthodontics, and veterinary medicine. History The first person to document a surgery was the 6th century BC Indian physician-sur ...

surgeon
commonly credited as the author of the treatise Sushruta Samhita. He is well known as the "father of surgery", and his period is usually placed around 1200–600 BC. One of the earliest known mentions of the name is from the ''Bower Manuscript'', in which Sushruta is listed as one of the ten sages residing in the Himalayas.Kutumbian, pp. xxxii–xxxiii Texts suggest that he learned surgery at Varanasi, Kasi from Lord Dhanvantari, the god of medicine in Hindu mythology. It is one of the oldest known surgical texts and it describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures for various forms of cosmetic surgery, plastic surgery and
rhinoplasty Rhinoplasty ( , nose + , to shape), commonly known as a nose job, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions ...

rhinoplasty
.


Ancient Greece

Image:Hippocrates rubens.jpg, 160px, Hippocrates stated in the oath (c. 400 BC) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists In ancient Greece, temples dedicated to the healer-god Asclepius, known as ''Asclepieia'' ( el, Ασκληπιεία, sing. ''Asclepieion'' ''Ασκληπιείον''), functioned as centers of medical advice, prognosis, and healing. In the Asclepieion of Epidaurus, some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place. The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations – including brain and eye surgery – that were not tried again for almost two millennia. Researchers from the Adelphi University discovered in the Paliokastro on Thasos ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery. According to the researchers: "The very serious trauma cases sustained by both males and females had been treated surgically or orthopedically by a very experienced physician/surgeon with great training in trauma care. We believe it to have been a military physician". The researchers were impressed by the complexity of the brain surgical operation.


Islamic World

During the Islamic Golden Age, largely based upon Paul of Aegina's ''Pragmateia'', the writings of Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Al-Andalus, Andalusian-Arab physician and scientist who practiced in the Zahra suburb of Córdoba, Spain, Córdoba, were influential. Al-Zahrawi specialized in curing disease by cauterization. He invented several
surgical instruments A surgical instrument is a tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of ...
for purposes such as inspection of the interior of the urethra and for removing foreign bodies from the throat, the ear, and other body organs. He was also the first to illustrate the various cannulae and to treat warts with an iron tube and caustic metal as a boring instrument. He describes what is thought to be the first attempt at reduction mammaplasty for the management of gynaecomastia and the first mastectomy to treat breast cancer. He is credited with the performance of the first thyroidectomy. Al-Zahrawi pioneered techniques of neurosurgery and neurological diagnosis, treating head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache. The first clinical description of an operative procedure for hydrocephalus was given by Al-Zahrawi, who clearly describes the evacuation of superficial intracranial fluid in hydrocephalic children.


Early modern Europe

In Europe, the demand grew for surgeons to formally study for many years before practicing; universities such as University of Montpellier, Montpellier, University of Padua, Padua and University of Bologna, Bologna were particularly renowned. In the 12th century, Rogerius (physician), Rogerius Salernitanus composed his ''Chirurgia'', laying the foundation for modern Western surgical manuals. Barber surgeon, 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. There were some important advances to the art of surgery during this period. The professor of anatomy at the University of Padua, Andreas Vesalius, was a pivotal figure in the Renaissance transition from classical medicine and anatomy based on the works of Galen, to an empirical approach of 'hands-on' dissection. In his anatomic treaties ''De humani corporis fabrica'', he exposed the many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves. The second figure of importance in this era was Ambroise Paré (sometimes spelled "Ambrose"), a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Paré began to employ a less irritating emollient, made of egg yolk, rose oil and turpentine. He also described more efficient techniques for the effective ligature (medicine), ligation of the blood vessels during an amputation.


Modern surgery

The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe. An important figure in this regard was the Scottish surgical scientist, John Hunter (surgeon), John Hunter, generally regarded as the father of modern scientific surgery. He brought an empiricism, empirical and experimental approach to the science and was renowned around Europe for the quality of his research and his written works. Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others, he conducted his own surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans. He greatly advanced knowledge of venereal disease and introduced many new techniques of surgery, including new methods for repairing damage to the Achilles tendon and a more effective method for applying ligature of the arteries in case of an aneurysm. He was also one of the first to understand the importance of pathology, the danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and even tuberculosis often undid any benefit that was gained from the intervention. He consequently adopted the position that all surgical procedures should be used only as a last resort. Other important 18th- and early 19th-century surgeons included Percival Pott (1713–1788) who described Pott disease, tuberculosis on the spine and first demonstrated that a cancer may be caused by an environmental carcinogen (he noticed a connection between chimney sweep's exposure to soot and their high incidence of Chimney sweeps' carcinoma, scrotal cancer). Astley Paston Cooper (1768–1841) first performed a successful ligation of the abdominal aorta, and James Syme (1799–1870) pioneered the Symes Amputation for the ankle joint and successfully carried out the first Hemipelvectomy, hip disarticulation. Modern
pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ac ...
control through
anesthesia Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia (relief from or prevention of pain), par ...
was discovered in the mid-19th century. Before the advent of
anesthesia Anesthesia or anaesthesia (from Greek "without sensation") is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia (relief from or prevention of pain), par ...
, 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 diethyl ether, ether, first used by the American surgeon Crawford Long, and chloroform, discovered by Scottish obstetrician James Young Simpson and later pioneered by John Snow (physician), John Snow, physician to Queen Victoria. 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.


Infection and antisepsis

Unfortunately, the introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the Hungarian people, 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 dismissed his advice. Until the pioneering work of British surgeon Joseph Lister, 1st Baron Lister, Joseph Lister in the 1860s, most medical men believed that chemical damage from exposures to bad air (see "Miasma theory of disease, miasma") was responsible for infections in wounds, and facilities for washing hands or a patient's wounds were not available. Lister became aware of the work of French chemist Louis Pasteur, who showed that rotting and fermentation (food), fermentation could occur under Anaerobic infection, anaerobic conditions if micro-organisms were present. Pasteur suggested three methods to eliminate the micro-organisms responsible for gangrene: filtration, exposure to heat, or exposure to solution, chemical solutions. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop
antiseptic Antiseptics (from Greek ἀντί ''anti'', "against" and σηπτικός ''sēptikos'', "putrefactive") are antimicrobial substances that are applied to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. Antisept ...
techniques for wounds. As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, spraying carbolic acid on his instruments. He found that this remarkably reduced the incidence of gangrene and he published his results in ''The Lancet''. Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on the ''Antiseptic Principle of the Practice of Surgery'', which was reprinted in the ''British Medical Journal''.. Reprinted in Modernized version of text E-text, audio at Project Gutenberg. His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years. Lister continued to develop improved methods of antisepsis and asepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. Lister introduced the Steam Steriliser to sterilization (microbiology), sterilize equipment, instituted rigorous hand washing and later implemented the wearing of rubber gloves. These three crucial advances – the adoption of a scientific methodology toward surgical operations, the use of anaesthetic and the introduction of sterilised equipment – laid the groundwork for the modern invasive surgical techniques of today. The use of X-rays as an important medical diagnostic tool began with their discovery in 1895 by German physics, physicist Wilhelm Röntgen. He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treated photographic plate. Image:Acquapendente - Operationes chirurgicae, 1685 - 2984755.tif, Hieronymus Fabricius, ''Operationes chirurgicae'', 1685 File:John Syng Dorsey.jpg, John Syng Dorsey wrote the first American textbook on surgery File:1753 Traversi Operation anagoria.JPG, An operation in 1753, painted by Gaspare Traversi.


Surgical specialties

* General surgery *: * Breast surgery, Breast * Cardiothoracic surgery, Cardiothoracic * Colorectal surgery, Colorectal * Craniofacial surgery * Dental surgery * Endocrine surgery, Endocrine * Gynaecology * Neurosurgery * Ophthalmology * Surgical oncology, Oncological * Oral and maxillofacial surgery * Organ transplantation, Transplant * Orthopaedic surgery * Hand surgery * Otolaryngology * Pediatric surgery, Paediatric (Pediatric) * Plastic surgery, Plastic * Podiatric surgery * Skin surgery, Skin * Trauma surgery, Trauma * Urology * Vascular surgery, Vascular


Learned societies

* World Federation of Neurosurgical Societies * American College of Surgeons * American College of Osteopathic Surgeons * American Academy of Orthopedic Surgeons * American College of Foot and Ankle Surgeons * Royal Australasian College of Surgeons * Royal Australasian College of Dental Surgeons * Royal College of Physicians and Surgeons of Canada * Royal College of Surgeons in Ireland * Royal College of Surgeons of Edinburgh * Royal College of Physicians and Surgeons of Glasgow * Royal College of Surgeons of England


See also

* * * * * – for outpatient surgical procedures medical coding * * * * * – a family of health care databases etc. from the US * (International Classification of Diseases, 10th edition, Procedural Coding System; inpatient surgical procedures medical coding) * * List of surgical procedures * * * * * * * * * * * * *


Notes


References

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