A History of Surgery: Part I

V. A. Cyr
Feb 12
5 min read

Updated: Feb 19

In the last post, we discussed Anesthesia, which now brings us to the topic of Surgery! There are many reasons why a person would need surgery. What do surgical preparations look like versus post-operative care? In Part I, we will look into the different types of surgery and what is commonly used today to perform them. A History of Surgery: Part II will discuss the history behind the kinds of surgeries and how techniques have evolved over time.

Definitions & Types

The word surgery comes from the Greek words cheirourgia (surgery) or cheirourgos (surgeon), meaning “doing by hand” or “hand” (cheir) “work” (ergon). Surgery is a procedure used to fix a natural or unnatural defect in the body.

Purposes of Surgery

Diagnostic or Exploratory Surgery aims to find a cause of symptoms or illness. An example would be a tissue biopsy (part of the tissue is taken out and examined in a laboratory).
Therapeutic Surgery treats a condition that has already been diagnosed, like an appendectomy (removal of the appendix) for appendicitis (inflammation of the appendix).
Curative Surgery occurs when the entire disease pathology is removed during the procedure, curing the person of their ailment. For example, a thyroidectomy (removal of the thyroid) for someone with a thyroid tumour.
Preventative Surgery is done to avoid the possibility of a worse diagnosis later. An example would be having polyps removed from the colon during a colonoscopy (internal scope of the large intestine).
Reconstructive Surgery improves the appearance or function of the body. An example of appearance would be a rhinoplasty (nose job) after a broken nose. A functional example would be reconstructive knee surgery after a tear in the ACL (anterior cruciate ligament).
Transplantation Surgery is used to fix a body part that is no longer functioning. This can include organ transplantation (e.g., kidney transplant) or a hip replacement (arthroplasty).

Types of Surgery

General Surgery comprises anything done in the abdominal cavity (e.g., stomach, intestines, liver, gallbladder, blood vessels, etc.).
Orthopedic Surgery works on the bones in the body. The word orthopedic comes from the Greek words orthos (straight) and paidios (child).
Gynecological Surgery is performed on the female reproductive organs, hence the terms gyne (female) and logia (the study of).
Cardio-thoracic Surgery focuses on the heart (cardio) and lung cavity (thoracic).
Urological Surgery is performed on the urinary tract (e.g., kidneys, bladder, urethra, etc.). The term urology comes from the terms uro (urine) and logia (the study of).
Neurological Surgeries comprise procedures done on the brain, spinal cord, and nerves (neuro).
Plastic Surgery is performed to make the body more aesthetically pleasing and affirming. It can be done for reconstructive or cosmetic purposes.
Other types include more specific surgeries, such as ophthalmic (eye), otolaryngology (ear-nose-throat), maxillofacial (mouth), and orthognathic (jaw) surgeries.
The history and examples of these surgeries will be discussed in A History of Surgery: Part II.

Steps of a Surgical Procedure

Pre-Operative

In the pre-operative stage, the physician must determine the person’s eligibility for surgery. This includes assessing their medical history, diagnostic testing like vital signs and bloodwork (see A History of Bloodwork), and giving pre-operative instructions (e.g., no eating for 8 hours before surgery). This assessment will give the doctors an idea of the patient’s health status and how they will do when under anesthesia.

Intra-Operative

This is the period during which the procedure occurs, and the patient is “under.” During this, the doctors perform their techniques while the anesthesiologist ensures the patient is safe (See A History of Anesthesia). Usually, two surgeons and multiple other team members, such as nurses, are present to complete the procedure. Since surgeries are now performed in a sterile manner, many people are “scrubbed in” with the doctors to hand them the sterile equipment, and others are taking “clean” precautions to give them anything they need extra. “Scrubbing in” is a term used to describe cleaning your hands and arms and becoming sterile. Once hands have been washed, nothing can be touched. Sterility needs to be kept to prevent the risk of infection. The surgical team don hair covers, face masks, visors, sterile gowns and gloves. See A History of Wound Care for the steps to don sterile gloves and begin a sterile field. The sterile field in an operating theatre will be much larger than that created for wound care.

Example of a sterile field set up for a surgical procedure (JOMI News, n.d.).

Post-Operative

The post-operative period starts after the procedure. This time consists of close monitoring to ensure no side effects from the anesthesia. As time passes, healthcare providers shift focus to infection prevention and wound healing. Prophylactic antibiotics may be given to prevent any infection risk in the wound.

Operating Room

The operating room (OR) is the common name for the operating theatre. In the past, it was referred to as a theatre as medical students could come to watch the procedure. As new infection control measures and aseptic techniques became more popular, operating rooms became closed rooms, limiting the people viewing the surgery. The origins of specific surgeries will be discussed in Part II.

This is an example of an original operating theatre (Enfield, 2022). Note that no masks or gloves are being worn!

This is a surgical room from the early 20th Century (Enfield, 2022).

Here is an example of a modern-day operating room (Bodzek, 2005).

Surgical Instruments

Here are some of the modern instruments commonly used in surgeries.

Scalpels are tissue-cutting tools, essentially tiny knives. Their shape and size vary depending on the type of cut needed.

Types of scalpels (Visenio, n.d.).

Scissors are also used to cut tissues or sutures. These vary in shape from straight to more curved.

Different types of scissors (Visenio, n.d.).

Forceps are used to grab tissues or items. The tips can be smooth or serrated depending on what needs to be picked up.

Two different forceps, one without and one with a serrated tip (Visenio, n.d.).

Clamps can hold instruments or tissues in place. Hemostats are clamps that provide hemostasis (stop the bleeding).

Various types of clamps (Visenio, n.d.).

Needles and Sutures are used to close a wound. There are various types of needle and suture shapes and sizes. There are also different methods of suturing wounds. Skin glue, staples and clamps are also used to close wounds.

Types of sutures (MEDizzy, 2019).

Now that we have reviewed modern-day surgical practices, make sure to check out next weeks post – A History fo Surgery: Part II! We will discuss the origins of different types of surgeries. What surgery do you find most interesting?

– V. A. Cyr

References

Bodzek, P. (2005). Operating theatre [Image]. Wikipedia. https://en.wikipedia.org/wiki/File:Operating_theatre.jpg

Enfield, L. (2022). The original drama of operating theatres [Images]. Wellcome Collection. https://wellcomecollection.org/stories/the-original-drama-of-operating-theatre

MEDizzy. (2019). Different types of Surgical suturing techniques [Image]. https://medizzy.com/feed/5033938

JOMI News. (n.d.). Sterile Field [Image]. https://blog.jomi.com/tag/sterile-field/

Visenio, M. R. (n.d.). Commonly Used Surgical Instruments [Images]. ACS Division of Education Student Resource Task Force, American College of Surgeons. https://www.facs.org/media/wgcmalet/common_surgical_instruments_module.pdf