surgery | Definition, History, Type, & Techniques | Britannica

There are four major categories of surgery: (1) wound treatment, (2) extirpative surgery, (3) reconstructive surgery, and (4) transplantation surgery. The ... surgery TableofContents IntroductionHistoryPresent-daysurgery FastFacts 2-MinSummary RelatedContent Media Videos Images More MoreArticlesOnThisTopic Contributors ArticleHistory Home Health&Medicine Medicine surgery medicine Print print Print Pleaseselectwhichsectionsyouwouldliketoprint: TableOfContents Cite verifiedCite Whileeveryefforthasbeenmadetofollowcitationstylerules,theremaybesomediscrepancies. Pleaserefertotheappropriatestylemanualorothersourcesifyouhaveanyquestions. SelectCitationStyle MLA APA ChicagoManualofStyle CopyCitation Share Share Sharetosocialmedia Facebook Twitter URL https://www.britannica.com/science/surgery-medicine More GiveFeedback ExternalWebsites Feedback Corrections?Updates?Omissions?Letusknowifyouhavesuggestionstoimprovethisarticle(requireslogin). 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MerckManual-ConsumerVersion-Surgery ScienceMuseum-Surgery TheNewEnglandJournalofMedicine-TwoHundredYearsofSurgery BritannicaWebsites ArticlesfromBritannicaEncyclopediasforelementaryandhighschoolstudents. surgery-Children'sEncyclopedia(Ages8-11) surgery-StudentEncyclopedia(Ages11andup) By TheEditorsofEncyclopaediaBritannica • EditHistory surgery Seeallmedia KeyPeople: VictorChang JosephLister EdwardJenner BenCarson SanjayGupta ...(Showmore) RelatedTopics: transplant plasticsurgery roboticsurgery laparotomy gastricbypasssurgery ...(Showmore) Seeallrelatedcontent→ surgery,branchofmedicinethatisconcernedwiththetreatmentofinjuries,diseases,andotherdisordersbymanualandinstrumentalmeans.Surgeryinvolvesthemanagementofacuteinjuriesandillnessesasdifferentiatedfromchronic,slowlyprogressingdiseases,exceptwhenpatientswiththelattertypeofdiseasemustbeoperatedupon.Ageneraltreatmentofsurgeryfollows.Forfurthertreatments,seetherapeutics;medicine. BritannicaQuiz NameThatSurgery Haveyouundergoneamyringotomy?Howaboutalingualfrenectomy?Testyourknowledgeofsurgicalprocedureswiththisquiz. HistorySurgeryisasoldashumanity,foranyonewhohaseverstanchedawoundhasactedasasurgeon.Insomeancientcivilizationssurgeryreachedaratherhighlevelofdevelopment,asinIndia,China,Egypt,andHellenisticGreece.InEuropeduringtheMiddleAges,thepracticeofsurgerywasnottaughtinmostuniversities,andignorantbarbersinsteadwieldedtheknife,eitherontheirownresponsibilityoruponbeingcalledintocasesbyphysicians.TheorganizationoftheUnitedCompanyofBarberSurgeonsofLondonin1540markedthebeginningofsomecontrolofthequalificationsofthosewhoperformedoperations.ThisguildwastheprecursoroftheRoyalCollegeofSurgeonsofEngland.Inthe18thcentury,withincreasingknowledgeofanatomy,suchoperativeproceduresasamputationsoftheextremities,excisionoftumoursonthesurfaceofthebody,andremovalofstonesfromtheurinarybladderhadhelpedtofirmlyestablishsurgeryinthemedicalcurriculum.Accurateanatomicalknowledgeenabledsurgeonstooperatemorerapidly;patientsweresedatedwithopiumormadedrunkwithalcohol,tieddown,andalegamputation,forexample,couldthenbedoneinthreetofiveminutes.Thepaininvolvedinsuchprocedures,however,continuedtolimitexpansionofthefielduntiltheintroductionofetheranesthesiain1846.Thenumberofoperationsthereafterincreasedmarkedly,butonlytoaccentuatethefrequencyandseverityof“surgicalinfections.”WilliamThomasGreenMortonadministeringetheranesthesiaWilliamThomasGreenMortonadministeringetheranesthesiaduringthefirstsuccessfulpublicdemonstrationofitsuseduringsurgery,undatedengraving.ScienceHistoryImages/AlamyInthemid-19thcenturytheFrenchmicrobiologistLouisPasteurdevelopedanunderstandingoftherelationshipofbacteriatoinfectiousdiseases,andtheapplicationofthistheorytowoundsepsisbytheBritishsurgeonJosephListerfrom1867resultedinthetechniqueofantisepsis,whichbroughtaboutaremarkablereductioninthemortalityratefromwoundinfectionsafteroperations.Thetwinemergenceofanesthesiaandantisepsismarkedthebeginningofmodernsurgery.JosephListerJosephLister,1857.CourtesyoftheWellcomeTrustees,LondonWilhelmConradRöntgen’sdiscoveryofX-raysattheturnofthe20thcenturyaddedanimportantdiagnostictooltosurgery,andthediscoveryofbloodtypesin1901byAustrianbiologistKarlLandsteinermadetransfusionssafer.Newtechniquesofanesthesiainvolvingnotonlynewagentsforinhalationbutalsoregionalanesthesiaaccomplishedbynerveblocking(spinalandlocalanesthesia)werealsointroduced.Theuseofpositivepressureandcontrolledrespirationtechniques(topreventthelungfromcollapsingwhenthepleuralcavitywasopened)madechestsurgerypracticalandrelativelysafeforthefirsttime.Theintravenousadministration(injectionintotheveins)ofanestheticagentswasalsoadopted.Intheperiodfromthe1930stothe1960s,thereplenishmentofbodyfluidsbyintravenousinfusion,theintroductionofchemicalsandantibioticstofightinfectionandtotreatthemetabolicallydisturbedbody,andthedevelopmentofheart-lungmachineshelpedbringsurgerytoastateinwhicheverybodycavity,system,organ,andareacouldsafelybeoperatedon.WilhelmConradRöntgenWilhelmConradRöntgen.©Photos.com/JupiterimagesPresent-daysurgeryContemporarysurgicaltherapyisgreatlyhelpedbymonitoringdevicesthatareusedduringsurgeryandduringthepostoperativeperiod.Bloodpressureandpulseratearemonitoredduringanoperationbecauseafallintheformerandariseinthelattergiveevidenceofacriticallossofblood.Otheritemsmonitoredaretheheartcontractionsasindicatedbyelectrocardiograms;tracingsofbrainwavesrecordedbyelectroencephalograms,whichreflectchangesinbrainfunction;theoxygenlevelinarteriesandveins;carbondioxidepartialpressureinthecirculatingblood;andrespiratoryvolumeandexchange.Intensivemonitoringofthepatientusuallycontinuesintothecriticalpostoperativestage.Asepsis,thefreedomfromcontaminationbypathogenicorganisms,requiresthatallinstrumentsanddrygoodscomingincontactwiththesurgicalfieldbesterilized.Thisisaccomplishedbyplacingthematerialsinanautoclave,whichsubjectsitscontentstoaperiodofsteamunderpressure.Chemicalsterilizationofsomeinstrumentsisalsoused.Thepatient’sskinissterilizedbychemicals,andmembersofthesurgicalteamscrubtheirhandsandforearmswithantisepticordisinfectantsoaps.Sterilizedgowns,caps,andmasksthatfiltertheteam’sexhaledairandsterilizedglovesofdisposableplasticcompletethepicture.Thereafter,attentiontoavoidingcontactwithnonsterilizedobjectsisthebasisofmaintainingasepsis.autoclaveAutoclaveusedtosterilizemedicalinstruments.©PatriciaHofmeester/Shutterstock.comDuringanoperation,hemostasis(thearrestingofbleeding)isachievedbyuseofthehemostat,aclampwithratchetsthatgraspsbloodvesselsortissue;afterapplicationofhemostats,suturematerialsaretiedaroundthebleedingvessels.Absorbentsterilenapkinscalledsponges,madeofavarietyofnaturalandsyntheticmaterials,areusedfordryingthefield.Bleedingmayalsobecontrolledbyelectrocautery,theuseofaninstrumentheatedwithanelectriccurrenttocauterize,orburn,vesseltissue.Themostcommonlyusedinstrumentsinsurgeryarestillthescalpel(knife),hemostaticforceps,flexibletissue-holdingforceps,woundretractorsforexposure,crushingandnoncrushingclampsforintestinalandvascularsurgery,andthecurvedneedleforworkingindepth.Themostcommonmethodofclosingwoundsisbysutures.Therearetwobasictypesofsuturematerials;absorbableonessuchascatgut(whichcomesfromsheepintestine)orsyntheticsubstitutes;andnonabsorbablematerials,suchasnylonsutures,steelstaples,oradhesivetissuetape.Catgutisstillusedextensivelytotieoffsmallbloodvesselsthatarebleeding,andsincethebodyabsorbsitovertime,noforeignmaterialsareleftinthewoundtobecomeafocusfordiseaseorganisms.Nylonstitchesandsteelstaplesareremovedwhensufficienthealinghastakenplace.Therearethreegeneraltechniquesofwoundtreatment;primaryintention,inwhichalltissues,includingtheskin,areclosedwithsuturematerialaftercompletionoftheoperation;secondaryintention,inwhichthewoundisleftopenandclosesnaturally;andthirdintention,inwhichthewoundisleftopenforanumberofdaysandthenclosedifitisfoundtobeclean.Thethirdtechniqueisusedinbadlycontaminatedwoundstoallowdrainageandthusavoidtheentrapmentofmicroorganisms.Militarysurgeonsusethistechniqueonwoundscontaminatedbyshellfragments,piecesofclothing,anddirt.The20thand21stcenturieswitnessedseveralnewsurgicaltechnologiestosupplementthetechniquesofmanualincision.Lasersbecamewidelyusedtodestroytumoursandotherpigmentedlesions,someofwhichareinaccessiblebyconventionalsurgery.Theyarealsousedtosurgicallywelddetachedretinasbackinplaceandtocoagulatebloodvesselstostopthemfrombleeding.Stereotaxicsurgeryusesathree-dimensionalsystemofcoordinatesobtainedbyX-rayphotographytoaccuratelyfocushigh-intensityradiation,cold,heat,orchemicalsontumourslocateddeepinthebrainthatcouldnototherwisebereached.Cryosurgeryusesextremecoldtodestroywartsandprecancerousandcancerousskinlesionsandtoremovecataracts.Sometraditionaltechniquesofopensurgerywerereplacedbytheuseofathinflexiblefibre-optictubeequippedwithalightandavideoconnection;thetube,orendoscope,isinsertedintovariousbodilypassagesandprovidesviewsoftheinteriorofholloworgansorvessels.Accessoriesaddedtotheendoscopeallowsmallsurgicalprocedurestobeexecutedinsidethebodywithoutmakingamajorincision.Preoperativeandpostoperativecarebothhavethesameobject:torestorepatientstoasneartheirnormalphysiologicstateaspossible.Bloodtransfusions,intravenousadministrationoffluids,andtheuseofmeasurestopreventcommoncomplicationssuchaslunginfectionandbloodclottinginthelegsaretheprincipalfeaturesofpostoperativecare.Therearefourmajorcategoriesofsurgery:(1)woundtreatment,(2)extirpativesurgery,(3)reconstructivesurgery,and(4)transplantationsurgery.Thetechnicalaspectsofwoundsurgery,alreadypartlydiscussed,centreonprocuringgoodhealingandtheavoidanceofinfection.Extirpativesurgeryinvolvestheremovalofdiseasedtissueororgans.Cancersurgeryusuallyfallsintothiscategory,withmastectomy(removalofthebreast),cholecystectomy(removalofthegallbladder),andhysterectomy(removaloftheuterus)amongthemostfrequentprocedures.Reconstructivesurgerydealswiththereplacementoflosttissues,whetherfromfractures,burns,ordegenerative-diseaseprocesses,andisespeciallyprominentinthepracticeofplasticsurgeryandorthopedicsurgery.Graftsfromthepatientorfromothersarefrequentlyusedtoreplacelosttissues.Reconstructivesurgeryalsousesartificialdevices(prostheses)toreplacedamagedordiseasedorgansortissues.Commonexamplesaretheuseofmetalinreconstructinghipjointsandtheuseofplasticvalvestoreplaceheartvalves.Transplantationsurgeryinvolvestheuseoforganstransplantedfromotherbodiestoreplacediseasedorgansinpatients.Kidneysarethemostcommonlytransplantedorgans.Themajormedicalspecialtiesinvolvingsurgeryaregeneralsurgery,plasticsurgery,orthopedicsurgery,obstetricsandgynecology,neurosurgery,thoracicsurgery,colonandrectalsurgery,otolaryngology,ophthalmology,andurology.Generalsurgeryistheparentspecialtyandnowcentresonoperationsinvolvingthestomach,intestines,breast,bloodvesselsintheextremities,endocrineglands,tumoursofsofttissues,andamputations.Plasticsurgeryisconcernedwiththebodilysurfaceandwithreconstructiveworkofthefaceandexposedparts.Orthopedicsurgerydealswiththebones,tendons,ligaments,andmuscles;fracturesoftheextremitiesandcongenitalskeletaldefectsarecommontargetsoftreatment.Obstetriciansperformcesareansections,whilegynecologistsoperatetoremovetumoursfromtheuterusandovaries.Neurosurgeonsoperatetoremovebraintumours,treatinjuriestothebrainresultingfromskullfractures,andtreatrupturedintravertebraldisksthataffectthespinalcord.Thoracicsurgeonstreatdisordersofthelungs;thesubspecialtyofcardiovascularsurgeryisconcernedwiththeheartanditsmajorbloodvesselsandhasbecomeamajorfieldofsurgicalendeavour.Colonandrectalsurgerydealswithdisordersofthelargeintestine.Otolaryngologicsurgeryisperformedintheareaoftheear,nose,andthroat(e.g.,tonsillectomy),whileophthalmologicsurgerydealswithdisordersoftheeyes.Urologicsurgerytreatsdiseasesoftheurinarytractand,inmales,ofthegenitalapparatus.TheEditorsofEncyclopaediaBritannicaThisarticlewasmostrecentlyrevisedandupdatedbyAdamAugustyn.