The Development of Surgery Through the Years

From trepanation in prehistoric times to heart surgery in the 20th century to the laser-assisted procedures of today, tremendous progress has been made in how surgeons are able to identify patient symptoms and achieve better outcomes.

The advancement of surgical skills
One of the most important advancements in surgery was the discovery and use of anesthesia. Surgical records document the pain associated with early procedures performed without anesthesia, as well as the temerity necessary for patients to undergo these procedures. Surgeons were, in essence, limited to accepting patients who were willing to undergo a great deal of discomfort, which limited the development of new techniques.

Due to the pain un-anaesthetized patients suffered through during surgical procedures, the speed with which operations were performed became an overwhelming concern for surgeons before the mid-19th century. Once anesthetics came into wide use, surgeons were afforded more time to develop techniques and improve patient outcomes.

The next big development in surgery was antisepsis. Infection was no less of a concern under anesthesia, and for many years was far more prevalent than it should have been. It wasn’t until the late 1800s that the importance of cleanliness was emphasized, and with it, a new era of safer surgeries emerged.

Cleanliness has become vital in surgery.Cleanliness has become vital in surgery.

Teaching surgery: then and now
Understanding the development of surgical skills training requires recognizing the historical hurdles physicians have faced. Restrictions on the number of work hours, the high cost of operating room time, and, most saliently, an abiding need to treat patients ethically have all hindered training in the past.

New techniques for training surgeons have made the process easier and more efficient. One of the most important was the development of “box trainers,” a type of simulator that uses real surgical tools and a constructed simulation of the human abdominal cavity to acclimate physicians-in-training to surgical settings and procedures. This invention solved several of the problems associated with surgical training: It is much cheaper than reserving operating room time and avoids the patient safety and availability concerns associated with the use of actual bodies. Box trainers are not perfect, though, because they are hindered by the limited tactile response that comes about as a result of simulated human tissue.

One technique used to approximate the actual sensation of tissue is using anaesthetized animals as stand-ins. Such a practice allows humans to work together on a single “patient,” while creating the possibility of the sorts of complications that surgeons may encounter in practice. However, the practice of using animals for surgical training purposes is not widespread because of serious ethical concerns involved.

Luckily, the rise of new technologies has created a training technique that offers the best of both worlds. Virtual reality simulators have been developed to provide a more specialized environment than box trainers and allow surgeons to train in a much more believable and educational environment without needing to perform on actual tissue.

In addition, the physician can receive constant feedback and can adjust and learn from prior performances in real time. Surgeons can easily practice complicated procedures, allowing them to gain skills in a challenging space. For the patient, this means that once-risky procedures are safer and more readily available.

For more information on current surgical procedures, check out the 10th edition of Zollinger’s Atlas of Surgical Operations. For more than half-a-century,  Zollinger’s has been the gold-standard reference for learning how to perform the most common surgical procedures using safe, well-established techniques.

Zollinger’s Atlas of Surgical Operations, along with other leading surgery references, are also available on AccessSurgery.

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