A History of Surgery: Part II

V. A. Cyr
Feb 19
14 min read

Modern surgery has evolved from a long history of interesting techniques. For example, historically, bloodletting and leeching (see A History of Bloodwork) were standard techniques for relieving the body of “bad blood.” A History of Surgery: Part I gave us a primer on surgery and its connection to Anesthesia and Wound Care. In Part II, we will discuss the origins of surgery and common types and examples of modern surgeries. Diagrams are used to show procedures and surgical techniques; no real pictures are used.

Disclaimer—Here at Hippocampus History, we respect everyone and their right to live their own lives. When talking about men and women, we are referring to the sex in which the person was born, not their gender identity. Below, there is a discussion of transgender people and gender-affirming surgeries. This is a place to share experiences and learn new things. Feel free to skip any section that makes you uncomfortable, and please stay respectful in the comments section. Happy Learning!

Origins of Surgery

The oldest known amputation occurred 31,000 years ago in Borneo (Maloney et al., 2022). Remains with amputation marks have been found on a person’s lower left leg, which survived at least another six years after the surgery (Maloney et al., 2022).

Trepanation was common from 5000 to 3300 BCE, making it the earliest form of cranial surgery. It involves scraping or drilling a hole into the skull to relieve intracranial pressure. Today, it is still done (see craniotomy), but in a more sterile and controlled manner.

Different 17th-century methods of trepanation: (1) scraping, (2) grooving, (3) boring and cutting, and (4) rectangular intersecting cuts (MIT Press, 2021).

In 1600 BCE, the Edwin Smith Papyrus from Egypt outlined many cases of injuries, fractures, wounds, and tumours (van Middendorp et al., 2010). It describes using honey and mouldy bread as antiseptic, raw meat to prevent bleeding, and immobilization for patients with spinal cord injuries. It is the first known reference to breast cancer. Additionally, it also states that magic should only be used as a last resort!

Around 400 BCE, Hippocrates became the “Founder of Western Medicine.” The Hippocratic Oath is the code that every doctor must abide by, and Hippocrates believed that all doctors should keep their hands clean (Silverberg, 1967). He also was the first to distinguish benign and malignant tumours, believing that some tumours did not need to be surgically removed and possibly hastening death (Silverberg, 1967).

Aulus Cornelius Celcius wrote De Medicina around 50 CE, describing “dilated tortuous veins” around breast cancer (Di Lonardo et al., 2015). The word “cancer” comes from the Latin word for crab and was made popular by Galen around 200 CE ( (Di Lonardo et al., 2015)). Galen also pioneered suturing techniques, recommending surgical excision of cancers, and an advocate of drainage of “black bile” (see A History of Bloodwork; (Di Lonardo et al., 2015). Later on, Leonidas of Alexandria began advocating for the use of cautery in breast cancer surgery (Di Lonardo et al., 2015).

In 1163, the Council of Tours (run by Pope Alexander III) banned the “barbaric practice” of surgery to remove breast cancer (Bagwell, 2005). As time passed and the Black Plague ravaged Europe, many practices were changed. Alcohol was starting to be used as an antiseptic, medications used as anesthetics and wound techniques became more popular than letting the pus drain openly.

In 1735, Claudius Amyand performed the first successful appendectomy while fixing a hernia on an 11-year-old boy with no anesthesia (Hektoen Institute of Medicine, 2009). Amyand also worked on breast reconstruction, ankle fractures, biopsies, and reconstructive urology surgeries (Hektoen Institute of Medicine, 2009).

In 1773, Bernard Peyrilhe performed the first radical mastectomy, removing the breast tissue, pectoral muscle, and lymph nodes (Androutsos & Karamanou, 2009).

Around 1805, Aslet Cooper pioneered the ligation of arteries. This allowed for the stoppage of large bleeds and prevented deaths from blood loss caused by trauma or surgical intervention.

In the 1840s, anesthesia became more popular with the use of ether and nitrous oxide (see A History of Anesthesia).

Scottish surgeon William Macewen performed the first successful brain surgery in 1879 (Cohen, 2023). The procedure was a resection of a brain tumour.

In 1880, Ivar Sandstrom identified the parathyroid glands in humans and performed the first thyroidectomy (removal of the thyroid) to treat hyperthyroidism (Hannan, 2006).

Lawson Tait diagnosed an ectopic pregnancy via laparoscopy (EPF, 2025). He then performed the first successful salpingectomy (removal of the fallopian tubes) in 1883 (EPF, 2025).

In 1895, Ludwig Rehn performed the first cardiac surgery by suturing the heart of a man who had been stabbed (Blatchford, 1985).

Paul Kaznelson performed the first splenectomy (removal of the spleen) in 1916 to treat thrombocytopenia (low platelet count) (Remiker & Neunert, 2020).

Plastic surgery was born in 1917 after surgeons developed new facial reconstruction techniques for injuries sustained in World War I (NAM, n.d.). Harold Gillies treated the soldiers with skin and bone grafts with better outcomes than the facial prostheses and masks (NAM, n.d.).

The first cardiac surgery (mitral valve repair) was performed in 1925 by Henry Souttar in the UK (Sethia, 2018).

In the early 1900s, sex-reassignment surgery was becoming a topic in surgical areas. A pioneer in gender-affirming surgery is Dora Richter. In 1922, Richter underwent an orchiectomy (removal of the testes), and in 1931, they had a penectomy (removal of the penis) and vaginoplasty (creating a vagina) (Riedel, 2022).

In 1953, attempts were made to separate conjoined twins in the UK: two xyphopagus twins (joined at the sternum) were separated, and only one survived (Loughlin, 2005). This was a largely publicized event, and much scrutiny was involved. Now, with advances in medicine, twins can be separated close to birth without any complications, and some can even live forever conjoined to their twin.

The first coronary bypass surgery, or CABG (see below), was performed in 1967.

In 2013, the first nose was grown on a man’s forehead. A forehead flap is a flap of skin that is moved onto the forehead to grow as a skin graft. In this case, the skin grown was used to make a new nose for the patient. Flaps can be used all over the body to promote healing and reduce the risk of rejection of skin grafts. This is the modern-day version of what was used to help the WWI soldiers.

An example of a skin flap to fix a nasal skin defect (Mohs Reconstruction, 2020). A skin flap from the forehead covers a defect on the nose.

Organ Transplants

There have been many advances in surgery and, therefore, in organ transplants. The timeline below shows different transplant surgeries and when they occurred.

Timeline Throughout History: Transplant Surgeries

Uses of Surgery in Medicine

General Surgery

General surgery comprises anything done in the abdominal cavity (e.g., stomach, intestines, liver, gallbladder, blood vessels, etc.). These procedures can be performed laparotomy (one large incision on the lower right quadrant), laparoscopically (multiple small incisions using a camera), or endoscopically (through an endoscope placed into the esophagus). Some examples include:

Appendectomy is the removal of the appendix because of appendicitis (inflammation of the appendix) or rupture (peritonitis or infection in the abdominal cavity). This can be performed as a laparotomic or laparoscopic procedure.

Diagram of a laparoscopic (left) versus laparotomic (right) appendectomy (ACS, 2022).

Cholecystectomy is the removal of the gallbladder. This would be done to treat gallstones or other symptoms from gallstones (e.g., pain, jaundice, inflammation, etc.). This can also be done via laparotomy or laparoscopy. The gallbladder is responsible for storing bile made in the liver, aiding digestion. However, it is an organ that people can live without! After removal, the body will accommodate and create a new storage space within the bile duct.

Diagram of before and after a cholecystectomy (GBMC, n.d.).

Ostomies are created to help heal damage to the digestive tract (intestines or colon). This can be caused by constipation, bowel obstruction, or bowel rupture. This procedure is essentially separating the intestines and making a new exit through a stoma (hole) created in the abdominal wall. Ileostomies are done in the small intestine (usually in the ileum), and a colostomy is an ostomy in the colon. They can be permanent or temporary, depending on the extent of the bowel removed during the surgery. Ostomies require special wound care techniques to ensure a good seal around the stoma and the ostomy bag is well connected to avoid any leakage of fecal matter. A type of ostomy called a urostomy can be done to reroute urine from the kidneys.

Examples of a urostomy, ileostomy and colostomy placement (Cleveland Clinic, 2024b). They can be placed anywhere around the abdominal wall, preferably on a flat surface.

Orthopedic Surgery

Orthopedic surgery works on the musculoskeletal system, including bones, muscles, tendons, and ligaments.

ACL Reconstruction is the repair of a damaged anterior cruciate ligament in the knee. This is a common injury in athletes. This is commonly done with an arthroscope, a scope used to view the inside of joints. This surgery is done to repair the torn ACL back to its original location, which is done using buttons and screws to keep the ACL graft in place inside the joint.

This is a view of ACL reconstruction after the surgery (the original AC ligament is in the middle in turquoise) (Pai, 2024).

Knee Arthroplasty surgery is the partial or total replacement of the knee. A partial replacement only replaces the damaged tissues, while a total replacement replaces the entire knee joint. This is usually done to treat different types of arthritis, including osteoarthritis, rheumatoid, and posttraumatic arthritis following an injury.

Total (left) versus partial (right) knee replacement (Goobdones Orthopaedics, 2012).

Hip Arthroplasty or hip replacement is a surgery to replace the damaged parts of the hip joint, the pelvic bone and/or the head of the femur. This is also done in patients suffering from arthritis and traumatic injuries (broken hip). This can also be done as a partial or total hip replacement. A partial replacement is when the surgeon replaces the ball joint of the hip joint (head of the femur). A total hip replacement is when both the femur head and socket (acetabulum) in the pelvic bone are replaced.

There are steps to a total hip replacement: (1) removal of the damaged femur head, (2) attachment of the new ball and socket prostheses, and (3) insertion of the ball back into the socket (OSMI, 2025).

Gynecological Surgery

Gynecological surgery is performed on the female reproductive organs. These can be done on an elective (planned) or emergency basis.

Cesarean Section (C-section or Cesarean delivery) is a surgical procedure performed to deliver a baby through the abdomen rather than vaginally. This may be done in an emergency if the mother or the baby is not doing well with vaginal birth. This can occur from maternal fatigue, the mother’s hips being too small, the baby being too big, or any other medical issue arising during labour and delivery. The incision is commonly done horizontally on the lower pelvis but can also be done vertically as required. The baby is then removed from the uterus, followed by the placenta. There are more risks to giving birth in this manner (e.g., infection, healing, etc.), but this is a life-saving procedure that has helped many people be born. Women can have babies vaginally after a C-section, called a vaginally birth after C-section or VBAC. However, this is not always recommended, depending on the mother’s health and gynecological history.

Steps of a C-section (Advin, 2022).

Hysterectomy is the removal of the uterus. Salpingectomy and Oophorectomy are the removals of the fallopian tubes and ovaries, respectively. These can all be done during the same procedure. These organs can be removed through the abdomen with an incision or laparoscopically, or vaginally. This surgery is done in patients with cancer, gynecological issues (e.g., endometriosis, fibroids, unusual bleeding post-menopause, etc.), and as part of gender-affirming procedures. Depending on what organs need to be removed will dictate which type of hysterectomy is performed. A total hysterectomy removes the entire uterus. A total hysterectomy with bilateral salpingo-oophorectomy removes the uterus, fallopian tubes, ovaries, and cervix. A supracervical hysterectomy keeps the cervix intact at the end of the vaginal canal. A radical hysterectomy removed everything, including the cervix and the end portion of the vaginal canal. Removing these organs would send the woman into menopause, and may require hormone replacement therapy (estogren) if the ovaries are removed.

Different types of hysterectomies (Cleveland Clinic, 2024a).

Cardiothoracic Surgery

Cardio-thoracic surgery focuses on the heart and lungs. Heart and lung transplants are needed in cases where the patient has a failing heart and/or lungs. Since transplant surgery is just changing one organ out for another, we will focus on another standard procedure: the CABG.

Coronary Artery Bypass Grafting (CABG) is called “bypass surgery.” This is a surgery needed for patients suffering from coronary artery disease and atherosclerosis (congestion and hardening of the blood vessels). A coronary artery in the heart is blocked and must be fixed by bypassing it with a new blood vessel from the chest, arm or leg. The blood vessel is attached above the blocked artery, which allows for a new route for the blood to flow to the affected muscle. The number of coronary arteries needing a bypass distinguishes what level of CABG is required (single, double, etc.).

This diagram shows an example of different levels of CABG surgeries (Leach, 2020).

Urological Surgery

Urological surgery is performed on the urinary tract (e.g., kidneys, bladder, urethra, etc.)

Cystectomy is the removal of parts of the bladder (partial) or the entire bladder (radical cystectomy). This can be done in the case of bladder cancer. Once the bladder is removed, the urine can be rerouted from the kidneys via urostomy (see above). If cancer is suspected, the organs and lymph nodes surrounding the bladder (e.g., uterus, fallopian tubes, etc.) will likely also be removed.

Examples of radical cystectomy in males (left) and females (right) (Medicare Spots, 2023).

Trans-Urethral Resection of the Prostate (TURP) removes a part or the entire prostate through the urethra. The prostate is an organ that only males have that is used to create the liquid portion of semen, helping the sperm be more mobile to increase the chances of procreation. Prostate enlargement and cancer are common in older men, and this is a standard, less invasive procedure.

An example of a normal (left) and enlarged (middle) prostate around a bladder, versus the prostate after the TURP (Keystone Urology Specialists, 2025).

Vasectomy is the sterilization method for male patients. It is when surgeons cut through the vas deferens to inhibit sperm from getting from the testicles to the penis for ejaculation. The two vas deferens (one for each testicle) are divided and tied off using cauterization or attaching a metal cover on the ends to prevent reattachment. Usually, this is an elective surgery done once a man decides he does not want children. It is much less invasive than a hysterectomy. Although it is a form of permanent birth control, unlike hysterectomy, vasectomies can be reversed.

The diagram shows the separation of the vas deferens (Cleveland Clinic, 2022).

Neurological Surgery

Neurological surgeries comprise brain, spinal cord, and nerve procedures.

Craniotomy is a procedure in which a hole is made in the skull. It is the modern version of trepanation. As we know, inflammation is the first healing step (see A History of Wound Care). Since the brain cannot swell beyond the skull, it can be dangerous and increase the pressure inside. This procedure may relieve pressure on the brain in injuries with increased intracranial pressure.

Here is a diagram of a craniotomy showing all the layers beneath the scalp (NCI, n.d.).

Lumbar Puncture, also known as a “spinal tap,” is used as a diagnostic tool. The lumbar is a section of the spine. The puncture is performed into the spinal cord to retrieve cerebrospinal fluid (CSF) for laboratory testing. This procedure must be completely sterile. If any bacteria gets into the CSF and travels to the brain, there is a high risk of infection and severe complications.

This is a great image showing all the layers of the spinal column and where the lumbar puncture is taken (Health Central, 2020).

Plastic Surgery

Plastic surgery is performed to make the body more aesthetically pleasing and affirming. It can be done for reconstructive or cosmetic purposes, such as breast augmentation (mammoplasty) or gender-affirming surgery (e.g., “top” or “bottom” surgery).

Gender-affirming Surgeries occur when someone wants to transition from female to male or male to female. Female-to-male gender-affirming surgery is when a person born female gets procedures to change their female genitalia into male genitalia. Male-to-female gender-affirming surgery is when a person born male gets procedures to change their male genitalia into female genitalia. These procedures can encompass many different surgeries like mammoplasty (removal or implantation of breasts), sex-change surgeries, facial surgeries (e.g., facial feminizing), etc.
Mammoplasty is commonly known as a “boob job.” This can be done to reduce the size of the breast tissue, lift the breast, or insert an implant into the breast area. Breast reduction surgery can be done as a result of having a lot of breast tissue (leading to other issues such as back pain), having different-sized natural breasts, or a disease process like cancer. Breast lifts and implants are usually done as a cosmetic procedure. The surgeons operate in different areas around the nipple and areola to change the breast size. This can leave the patient with large incision wounds and scarring, either a vertical scar or an anchor-like scar.

Different types of breast reduction styles (SouthWest Breast Clinic, 2011).

Rhinoplasty is more commonly called a “nose job.” This is a common cosmetic procedure, but it is also seen in traumatic cases of injury or damaged nasal passageways (e.g., collapsed nasal septum). This procedure can be open (incision made across one nostril to the other) or closed (done within the nostrils). To reshape the nose, cartilage and bone are shaved or added (from rib or ear cartilage).

An example of reshaping the nasal bones and cartilage (Jalal Surgial, 2023).

I have spent the majority of my nursing career in the surgical field–I love it! I find surgery fascinating. I have cared for patients getting orthopedic, general, gynecological, and even dental surgeries. Any specific surgery you would like to learn more about?

– V. A. Cyr

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