THE RISE OF MODERN SURGERY

Jillian Georgina T. Yap, MD

 Objectives
• At the end of this session, the learner must be able to:
• Recall the most significant events of historical value in the field of Surgery

• Identify some prominent figures who pioneered in the field of Surgery

• Correlate the importance of the significant events in history to the present and future
 • Surgery
• Chirurgia (Latin)
• “branch of medicine concerned with diseases and
conditions requiring or amenable to operative or
manual procedures” -- Merriam
Definition Webster

• medical specialty that uses operative manual and

instrumental technique on a patient to investigate
or treat a pathological condition such as disease or
injury, to help improve bodily function or
appearance, or to repair unwanted ruptured areas
 Prehistoric Era
• Trepanation
• 3000-6000 BC
• first evidence of a surgical
procedure
• Drainage of abscess
• Amputation of limb
• Circumcision
• Setting of fractures
Middle Age & • Surgeons were often barber-surgeons
• minor procedures : tooth extraction,
Renaissance bloodletting, and treating war wounds
 EVOLUTION TO “SCIENTIFIC SURGERY”

four key elements

• knowledge of anatomy
• control of bleeding
• control of pain
• control of infection
knowledge of
anatomy
 Andreas Vesalius
• De Humani Corporis Fabrica Libri Septem
• assertied that dissection had to be
completed hands-on by physicians
themselves.
• his work paved the way for wide-ranging
research into human anatomy
 William harvey
• Function of the heart and circulation of
blood
• showed that the heart acts as a pump and
forces blood along the arteries and back
via veins, forming a closed loop.
CONTROL
OF
BLEEDING
 AMBROSE PARÉ
• proposed a method to control
hemorrhage during a surgical
operation
• represents a severing of the final link
between the surgical thoughts and
techniques of the ancients and the
push toward a more modern era
• Became surgeon-in-chief to 4 French
kings
• ligating or tying off blood vessels
during amputation
 Jean-Louis Petit

• invented the screw compressor

tourniquet
 William Bovie

• experimented with a less cumbersome surgical

device that contained two separate electric
circuits, one to incise tissue without bleeding
and the other simply to coagulate
• electrocautery
CONTROL OF PAIN
 NITROUS OXIDE
• laughing gas
• individuals lost their sense of
equilibrium, carried on without
inhibition, and felt little discomfort as
they clumsily knocked into nearby
objects
• physicians and dentists realized that
the pain-relieving qualities might be
applicable to surgical operations and
tooth extractions
 William T.G. Morton

• American dental surgeon

• gave the first successful public demonstration
of ether anesthesia during surgery in 1846.
OTHER ANESTHESIA BREAKTHROUGHS
• William Halsted
• used cocaine and infiltration anesthesia (nerve-
blocking) with great success in more than 1000
surgical cases
• James Corning
• carried out the earliest experiments on spinal
anesthesia, which were soon expanded on by
August Bier
• By the late 1920s, spinal anesthesia and epidural
anesthesia were widely used in the United States and
Europe.
• The next great advance in pain-free surgery occurred in
1934 -- introduction of (sodium thiopental [Sodium
Pentothal])
CONTROL OF
INFECTION
 JOSEPH LISTER
• efforts to control surgical infection through
antisepsis
• used carbolic acid (phenol) as sterilizing agent
• devised an absorbable suture impregnated with
phenol
 Ernst von Bergmann

• concept of asepsis
• recommended heat/steam sterilization (1886) of
surgical instruments as the ideal method to
eradicate germs.
SURGERY DURING THE WAR
• greatest surgical achievement at this
time was in the treatment of wound
infection
• wound treatment entailing débridement
and irrigation
• Henry Dakin, Alexis Carrel
 OTHER ADVANCES THAT
FURTHERED THE RISE OF
MODERN SURGERY
 XRAYS
• Wilhelm Roentgen
• professor of
physics at
Würzburg
University in
Germany
• discovered X-rays
in 1895
accidentally while
testing whether
cathode rays
could pass
through glass
 BLOOD TRANSFUSION

• Late 19th century

• Halsted on performed BT
to his sister for
postpartum hemorrhage
with blood drawn from
his own veins
• Karl Landsteiner
• George Crile
• Richard Lewisohn
• Geoffrey Keynes, Bernard
Fantus
• Charles Drew
 Ascent of scientific surgery
• establishment of self-regulatory and licensing
bodies
• specialty journals to disseminate news of surgical
research and technical innovations promptly
• Residency programs
Experimental Surgical Research Laboratories

• provided residents with opportunities to evaluate

surgical problems in an analytic fashion
Professional Societies and Licensing
Organizations
• Certifying board specialties
• evaluating candidates with written and
oral examinations as well as face-to-
face interviews
MODERN
ERA
 surgical firsts

• Alfred Blalock
• Allen Oldfather Whipple
• surgeons considered kidney transplantation, the replacement of arteries by
grafts, intravenous hyperalimentation, hemodialysis, vagotomy and
antrectomy for peptic ulcer disease, closed chest resuscitation for cardiac
arrest, the effect of hormones on cancer, and topical chemotherapy of burns
 post–World War II surgery
• growth of cardiac surgery and organ transplantation
• Dwight Harken
• Harken, Bailey
• Charles Hufnagel – prosthetic valve
• Donald Murray
• Blalock-Taussig-Thomas
• John H. Gibbon, Jr. – heart lung machine
• Michael DeBakey
• best-known
American
surgeon of the
modern era
• Alexis Carrel
• David Hume (1917-1973), John Merrill (1917-1986), Francis Moore, and
Joseph Murray - kidney transplant
• 1963 - first human liver transplant occurred thru efforts
• Christiaan Barnard – human heart transplant
 DIVERSITY

• evolution of surgery has been influenced by ethnic, gender,

racial, and religious bias
• discrimination, particularly in African Americans, women, and
certain immigrant groups
 TOWARDS THE FUTURE
• Arthrobot
• Laparoscopic surgery
• SILS
• NOTES
• Da Vinci
FUTURE TRENDS
R.I.P.
THANK YOU