INTRODUCTION

TO SURGERY
SIEGFRIED JAMES T. YAP, MD
GENERAL, CANCER AND LAPAROSCOPIC
SURGEON
DEPARTMENT OF SURGERY
AMA SCHOOL OF MEDICINE
 Latin, chirurgia
cheirourgia, from the Greek "cheir" meaning
"hand" + "ergon" meaning "work
is the branch ofmedicinethat deals with the
physical manipulation of a bodily structure to
diagnose, prevent, or cure an ailment

SURGERY (CHIRURGERY)
Ambroise Par, a 16th-century
French surgeon, stated that to
perform surgery is, "To eliminate
that which is superfluous, restore
that which has been dislocated,
separate that which has been
united, join that which has been
divided and repair the defects of
nature."
There is no more
science in surgery
than in butchering.
- Lord Thurlow
Parliamentary debate on the establishment of a
Royal College of Surgeons in 1811
Since humans first learned to make and handle tools, they have
employed their talents to develop surgical techniques, each time
more sophisticated than the last; however, until theindustrial
revolution, surgeons were incapable of overcoming the three
principal obstacles which had plagued the medical profession from
its infancy bleeding, painandinfection.
Advances in these fields have transformed surgery from
a risky "art" into a scientific discipline capable of treating
many diseases and conditions.
The first surgical techniques were developed to treat injuries and
traumas.
A combination of archaeological and anthropological studies offer
insight into man's early techniques for suturing lacerations,
amputating unsalvageable limbs, and draining and cauterizing
open wounds.
The oldest operation for which evidence exists
istrepanation(also known as trepanning, trephination,
trephining or burr hole), in which a hole isdrilled or scraped into
theskullfor exposing thedura materto treat health problems
related to intracranial pressure and other diseases.
The remains suggest a belief that trepanning could cureepileptic
seizures, migraines, and mental disorders.
Examples of healed fractures in prehistoric human bones,
suggesting setting and splinting have been found in the
archeological record.
Among some treatments used by the Aztecs, according to Spanish
texts during the conquest of Mexico, was the reduction of
fractured bones: "...the broken bone had to be splinted,
extended and adjusted, and if this was not sufficient an
incision was made at the end of the bone, and a branch of
firwas inserted into the cavity of themedulla..."
Modern medicine developed a
technique similar to this in the
20th century known as
medullary fixation.
Bloodletting is one of the oldest medical practices, having been
practiced among diverse ancient peoples, including
theMesopotamians, theEgyptians, the Greeks, theMayans, and
the Aztecs.
The art of bloodletting became very popular in theWest, and
during theRenaissanceone could find bloodletting calendars that
recommended appropriate times to bloodlet during the year and
books that claimed bloodletting would cureinflammation,
infections, strokes, manic psychosisand more.
Barber-surgeons were medical
practitioners who provided a wide-
range of services during the
medieval and early modern periods
of history.
Traditionally, they were trained
through apprenticeships, which could
last as long as 7 years.
Many had no formal education, and
some were even illiterate.
The barber-surgeons tasks ranged
from the mundanesuch as picking
lice from a persons head, trimming
or shaving beards, and cutting hair
to the more complicatedsuch as
extracting teeth, performing minor
surgical procedures and, of course,
bloodletting.
It is this last service which
epitomizes the barbers pole.
The original barbers pole has a brass ball at
its top, representing the vessel in which
leeches were kept and/or the basin which
received the patients blood.
The pole itself represents the rod which the
patient held tightly during the bloodletting
procedure to show the barber where the veins
were located.
The red and white stripes represents the
bloodied and clean bandages used during the
procedure. Afterwards, these bandages were
washed and hung to dry on the rod outside the
shop. The wind would twist the bandages
together, forming the familiar spiral pattern we
see on the barber poles of today.
After the establishment of
the Barber-Surgeons
Company in 1540, a
statute was passed that
required barbers and
surgeons to distinguish
their services by the
colours of their pole.
Sushruta(c. 600 BCE) is dubbed as the "founding father of
surgery".
His period is usually placed between the period of 1200 BC - 600
BC.
He was an early innovator of plastic surgery who taught and
practiced surgery on the banks of the GangesinNorthern India.
Much of what is known about Sushruta is inSanskritcontained in a
series of volumes he authored, which are collectively known as
theSushruta Samhita.
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 on performing various
forms of cosmetic surgery,plastic surgeryandrhinoplasty.
Galen, On the Natural Faculties, Books I, II, and III, is an excellent
paradigm of a very accomplished Greek surgeon and physician of
theRoman era(2nd century), who carried out very complex
surgical operations and added significantly to the corpus of animal
and human physiology and the art of surgery.
He was one of the first to useligaturesin his experiments on
animals.
Galen is also known as "The king of the catgut suture"
The professor of anatomy at
theUniversity of Padua, Andreas
Vesalius, was a pivotal figure in
theRenaissancetransition from
classical medicine and anatomy
based on the works ofGalen, to an
empirical approach of 'hands-on'
dissection.
In his anatomic treatis,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 discipline of surgery was put on a sound, scientific footing
during theAge of Enlightenmentin Europe.
An important figure in this regard was the Scottish surgical
scientist,John Hunter(1723-1798), generally regarded as the
father of modern scientific surgery. He brought
anempiricalandexperimental approach to the science and was
renowned around Europe for the quality of his research and his
written works.
Modernpaincontrol throughanesthesiawas discovered in the
mid-19th century.
Before the advent ofanesthesia, surgery was a traumatically
painful procedure and surgeons were encouraged to be as swift as
possible to minimize patientsuffering.
This also meant that operations were largely restricted
toamputationsand external growth removals.
Beginning in the 1840s, surgery began to change dramatically in
character with the discovery of effective and practical anaesthetic
chemicals such asether, first used by the American
surgeonCrawford Long, andchloroform, discovered byJames
Young Simpsonand later pioneered byJohn Snow, physician
toQueen Victoria.
In addition to relieving patient suffering, anaesthesia allowed
more intricate operations in the internal regions of the human
body.
In addition, the discovery ofmuscle relaxantssuch ascurare
allowed for safer applications.
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
theHungarian doctorIgnaz Semmelweiswho 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 theRoyal Societydismissed his advice.
Until the pioneering work of British surgeonJoseph Listerin the
1860s, most medical men believed that chemical damage from
exposures to bad air was responsible forinfectionsin wounds, and
facilities for washing hands or a patient'swoundswere not
available.
Lister became aware of the work of Frenchchemist Louis
Pasteur, who showed that rotting andfermentationcould occur
underanaerobic conditionsifmicro-organismswere present.
Lister experimented with sprayingcarbolic acid on his
instruments. He found that this remarkably reduced the incidence
of gangrene and he published his results in The Lancet.
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
ofantisepsisandasepsiswhen 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 tosterilizeequipment,
instituted rigorous hand washing and later implemented the wearing
of rubber gloves. His discoveries paved the way for a dramatic
expansion to the capabilities of the surgeon; for his contributions he
is often regarded as the father of modern surgery.
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.
SURGICAL
SPEAK
The language of surgery is quite simple
if you master a few suffixes.
Define the suffix:
-ectomy
To surgically remove part of or an entire
structure/organ
-orraphy
Surgical repair
-otomy
Surgical incision into an organ
-ostomy
Surgically created opening between
two organs, or organ and skin
-plasty
Surgical shaping or formation
NOW TEST YOUR
KNOWLEDGE OF
SURGICAL SPEAK:
Word for the surgical repair of a
hernia?

HERNIORRHAPHY
Word for the surgical removal of
the stomach?

GASTRECTOMY
Word for the surgical creation
of an opening between the
colon and the skin?

COLOSTOMY
Word for the surgical formation
of a new pylorus?

PYLOROPLASTY
Word for the surgical opening
of the stomach?

GASTROTOMY
Surgical creation of an opening
(anastomosis) between the
common bile duct and jejunum?

CHOLEDOCHOJEJUNOSTO
MY
Surgical creation of an opening
(anastomosis) between the
stomach and jejunum?

GASTROJEJUNOSTOM
Y
SURGEONS ARE
DOCTORS
AMONG
DOCTORS.