Surgery (from the Greek: χειρουργική cheirourgikē, via Latin: chirurgiae, meaning

"hand work") is a medical specialty that uses operative manual and instrumental
techniques on a patient to investigate and/or treat a pathological condition such as
disease or injury, to help improve bodily function or appearance, and sometimes for
religious reasons. An act of performing surgery may be called a surgical procedure,
operation, or simply surgery. In this context, the verb operate means performing
surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments
or surgical nurse. The patient or subject on which the surgery is performed can be a
person or an animal. A surgeon is a person who performs operations on patients. In
rare cases, surgeons may operate on themselves. Persons described as surgeons are
commonly physicians, but the term is also applied to podiatric physicians, dentists (or
known as oral and maxillofacial surgeon) and veterinarians. Surgery can last from
minutes to hours, but is typically not an ongoing or periodic type of treatment.
The term surgery can also refer to the place where surgery is performed, or simply
the office of a physician, dentist / oral and maxillofacial surgeon, or veterinarian.

Definitions of surgery
Surgery is a technology consisting of a physical intervention on tissues.
As a general rule, a procedure is considered surgical when it involves cutting of a
patient's tissues or closure of a previously sustained wound. Other procedures that
do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be
considered surgery if they involve "common" surgical procedure or settings, such as
use of a sterile environment, anesthesia, antiseptic conditions, typical surgical
instruments, and suturing or stapling. All forms of surgery are considered invasive
procedures; so-called "noninvasive surgery" usually refers to an excision that does
not penetrate the structure being excised (e.g. laser ablation of the cornea) or to a
radiosurgical procedure (e.g. irradiation of a tumor).

Types of surgery
Surgical procedures are the commonly categorized by urgency, type of procedure,
body system involved, degree of invasiveness, and special instrumentation.
Based on timing: Elective surgery is done to correct a non-life-threatening condition,
and is carried out at the patient's request, subject to the surgeon's and the surgical
facility's availability. Emergency surgery is surgery which must be done promptly to
save life, limb, or functional capacity. A semi-elective surgery is one that must be
done to avoid permanently disability or death, but can be postponed for a short time.
Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis.
Therapeutic surgery treats a previously diagnosed condition.
By type of procedure: Amputation involves cutting off a body part, usually a limb or
digit. Replantation involves reattaching a severed body part. Reconstructive surgery
involves reconstruction of an injured, mutilated, or deformed part of the body.
Cosmetic surgery is done to improve the appearance of an otherwise normal
structure. Excision is the cutting out of an organ, tissue, or other body part from the
patient. Transplant surgery is the replacement of an organ or body part by insertion
of another from different human (or animal) into the patient. Removing an organ or
body part from a live human or animal for use in transplant is also a type of surgery.
By body part: When surgery is performed on one organ system or structure, it may
be classed by the organ, organ system or tissue involved. Examples include cardiac
surgery (performed on the heart), gastrointestinal surgery (performed within the
digestive tract and its accessory organs), and orthopedic surgery (performed on
bones and/or muscles).
By degree of invasiveness: Minimally invasive surgery involves smaller outer
incision(s) to insert miniaturized instruments within a body cavity or structure, as in
laparoscopic surgery or angioplasty. By contrast, an open surgical procedure or
laparotomy requires a large incision to access the area of interest.
By equipment used: Laser surgery involves use of a laser for cutting tissue instead of
a scalpel or similar surgical instruments. Microsurgery involves the use of an
operating microscope for the surgeon to see small structures. Robotic surgery makes
use of a surgical robot, such as the Da Vinci or the Zeus surgical systems, to control
the instrumentation under the direction of the surgeon.
[edit]Terminology
Excision surgery names often start with a name for the organ to be excised (cut out)
and end in -ectomy.
Procedures involving cutting into an organ or tissue end in -otomy. A surgical
procedure cutting through the abdominal wall to gain access to the abdominal cavity
is a laparotomy.
Minimally invasive procedures involving small incisions through which an endoscope
is inserted end in -oscopy. For example, such surgery in the abdominal cavity is
called laparoscopy.
Procedures for formation of a permanent or semi-permanent opening called a stoma
in the body end in -ostomy.
Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the
body part to be reconstructed and ends in -oplasty. Rhino is used as a prefix for
"nose", so rhinoplasty is basically reconstructive or cosmetic surgery for the nose.
Reparation of damaged or congenital abnormal structure ends in -rraphy.
Herniorraphy is the reparation of a hernia, while perineorraphy is the reparation of
perineum.
[edit]Description of surgical procedure
At a hospital, modern surgery is often done in an operating theater using surgical
instruments, an operating table for the patient, and other equipment. The
environment and procedures used in surgery are governed by the principles of
aseptic technique: the strict separation of "sterile" (free of microorganisms) things
from "unsterile" or "contaminated" things. All surgical instruments must be sterilized,
and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e.
handled in an unsterile manner, or allowed to touch an unsterile surface). Operating
room staff must wear sterile attire (scrubs, a scrub cap, a sterile surgical gown,
sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub
hands and arms with an approved disinfectant agent before each procedure.
Prior to surgery, the patient is given a medical examination, certain pre-operative
tests, and their physical status is rated according to the ASA physical status
classification system. If these results are satisfactory, the patient signs a consent
form and is given a surgical clearance. If the procedure is expected to result in
significant blood loss, an autologous blood donation may be made some weeks prior
to surgery. If the surgery involves the digestive system, the patient may be
instructed to perform a bowel prep by drinking a solution of polyethylene glycol the
night before the procedure. Patients are also instructed to abstain from food or drink
(an NPO order after midnight on the night before the procedure, to minimize the
effect of stomach contents on pre-operative medications and reduce the risk of
aspiration if the patient vomits during or after the procedure.
In the pre-operative holding area, the patient changes out of his or her street clothes
and is asked to confirm the details of his or her surgery. A set of vital signs are
recorded, a peripheral IV line is placed, and pre-operative medications (antibiotics,
sedatives, etc.) are given. When the patient enters the operating room, the skin
surface to be operated on is cleaned and prepared by applying an antiseptic such as
chlorhexidine gluconate or povidone-iodine to reduce the possibility of infection. If
hair is present at the surgical site, it is clipped off prior to prep application. The
patient is assisted by an anesthesiologist or resident to make a specific surgical
position, then sterile drapes are used to cover all of the patient's body except for the
surgical site and the patient's head; the drapes are clipped to a pair of poles near the
head of the bed to form an "ether screen", which separates the
anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).
Anesthesia is administered to prevent pain from incision, tissue manipulation and
suturing. Based on the procedure, anesthesia may be provided locally or as general
anesthesia. Spinal anesthesia may be used when the surgical site is too large or deep
for a local block, but general anesthesia may not be desirable. With local and spinal
anesthesia, the surgical site is anesthetized, but the patient can remain conscious or
minimally sedated. In contrast, general anesthesia renders the patient unconscious
and paralyzed during surgery. The patient is intubated and is placed on a mechanical
ventilator, and anesthesia is produced by a combination of injected and inhaled
agents.
An incision is made to access the surgical site. Blood vessels may be clamped to
prevent bleeding, and retractors may be used to expose the site or keep the incision
open. The approach to the surgical site may involve several layers of incision and
dissection, as in abdominal surgery, where the incision must traverse skin,
subcutaneous tissue, three layers of muscle and then peritoneum. In certain cases,
bone may be cut to further access the interior of the body; for example, cutting the
skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up
the rib cage.
Work to correct the problem in body then proceeds. This work may involve:
excision - cutting out an organ, tumor,[1] or other tissue.
resection - partial removal of an organ or other bodily structure.
reconnection of organs, tissues, etc., particularly if severed. Resection of organs such
as intestines involves reconnection. Internal suturing or stapling may be used.
Surgical connection between blood vessels or other tubular or hollow structures such
as loops of intestine is called anastomosis.
ligation - tying off blood vessels, ducts, or "tubes".
grafts - may be severed pieces of tissue cut from the same (or different) body or
flaps of tissue still partly connected to the body but resewn for rearranging or
restructuring of the area of the body in question. Although grafting is often used in
cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area
of the patient's body and inserted to another area of the body. An example is bypass
surgery, where clogged blood vessels are bypassed with a graft from another part of
the body. Alternatively, grafts may be from other persons, cadavers, or animals.
insertion of prosthetic parts when needed. Pins or screws to set and hold bones may
be used. Sections of bone may be replaced with prosthetic rods or other parts.
Sometime a plate is inserted to replace a damaged area of skull. Artificial hip
replacement has become more common. Heart pacemakers or valves may be
inserted. Many other types of prostheses are used.
creation of a stoma, a permanent or semi-permanent opening in the body
in transplant surgery, the donor organ (taken out of the donor's body) is inserted into
the recipient's body and reconnected to the recipient in all necessary ways (blood
vessels, ducts, etc.).
arthrodesis - surgical connection of adjacent bones so the bones can grow together
into one. Spinal fusion is an example of adjacent vertebrae connected allowing them
to grow together into one piece.
modifying the digestive tract in bariatric surgery for weight loss.
repair of a fistula, hernia, or prolapse
other procedures, including:
clearing clogged ducts, blood or other vessels
removal of calculi (stones)
draining of accumulated fluids
debridement- removal of dead, damaged, or diseased tissue
Surgery has also been conducted to separate conjoined twins.
Sex change operations
Blood or blood expanders may be administered to compensate for blood lost during
surgery. Once the procedure is complete, sutures or staples are used to close the
incision. Once the incision is closed, the anesthetic agents are stopped and/or
reversed, and the patient is taken off ventilation and extubated (if general anesthesia
was administered).
After completion of surgery, the patient is transferred to the post anesthesia care
unit and closely monitored. When the patient is judged to have recovered from the
anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital
or discharged home. During the post-operative period, the patient's general function
is assessed, the outcome of the procedure is assessed, and the surgical site is
checked for signs of infection. If removable skin closures are used, they are removed
after 7 to 10 days post-operatively, or after healing of the incision is well under way.
Post-operative therapy may include adjuvant treatment such as chemotherapy,
radiation therapy, or administration of medication such as anti-rejection medication
for transplants. Other follow-up studies or rehabilitation may be prescribed during
and after the recovery period.
[edit]History

Main articles: History of surgery, Prehistoric medicine, and History of general

anesthesia
At least two prehistoric cultures had developed forms of surgery. The oldest for which
there is evidence is trepanation,[2] in which a hole is drilled or scraped into the skull,
thus exposing the dura mater in order to treat health problems related to intra
cranial pressure and other diseases. Evidence has been found in prehistoric human
remains from Neolithic times, in cave paintings, and the procedure continued in use
well into recorded history. Surprisingly, many prehistoric and premodern patients had
signs of their skull structure healing; suggesting that many survived the operation.
Remains from the early Harappan periods of the Indus Valley Civilization (c. 3300
BCE) show evidence of teeth having been drilled dating back 9,000 years.[3] A final
candidate for prehistoric surgical techniques is Ancient Egypt, where a mandible
dated to approximately 2650 BCE shows two perforations just below the root of the
first molar, indicating the draining of an abscessed tooth.
The oldest known surgical texts date back to ancient Egypt about 3500 years ago.
Surgical operations were performed by priests, specialized in medical treatments
similar to today. The procedures were documented on papyrus and were the first to
describe patient case files; the Edwin Smith Papyrus (held in the New York Academy
of Medicine) documents surgical procedures based on anatomy and physiology, while
the Ebers Papyrus describes healing based on magic. Their medical expertise was
later documented by Herodotus: "The practice of medicine is very specialized among
them. Each physician treats just one disease. The country is full of physicians, some
treat the eye, some the teeth, some of what belongs to the abdomen, and others
internal diseases."[4]
Other ancient cultures to have surgical knowledge include India, China and Greece.
Sushruta (also spelled Susruta or Sushrutha), c. 6th century BCE,is known as the
Father of Surgery. He was a renowned surgeon of Ancient India and the author of the
book Sushruta Samhita. In his book written in Sanskrit, he described over 120
surgical instruments, 300 surgical procedures and classifies human surgery into 8
categories. He performed Plastic Surgeries, Cataract operations and Cesarean. He
used to give a kind of herbal juice equivalent to anesthetics. He was a surgeon from
the Dhanvantari school of Ayurveda.[citation needed]
In ancient Greece, temples dedicated to the healer-god Asclepius, known as
Asclepieia (Greek: Ασκληπιεία, sing. Asclepieion Ασκληπιείον), functioned as centers
of medical advice, prognosis, and healing.[5] At these shrines, patients would enter a
dream-like state of induced sleep known as "enkoimesis" (Greek: ενκοίμησις) not
unlike anesthesia, in which they either received guidance from the deity in a dream
or were cured by surgery.[6] In the Asclepieion of Epidaurus, three large marble
boards dated to 350 BCE preserve the names, case histories, complaints, and cures
of about 70 patients who came to the temple with a problem and shed it there. Some
of the surgical cures listed, such as the opening of an abdominal abscess or the
removal of traumatic foreign material, are realistic enough to have taken place, but
with the patient in a state of enkoimesis induced with the help of soporific substances
such as opium.[7]
The Greek Galen was one of the greatest surgeons of the ancient world and
performed many audacious operations — including brain and eye surgery — that
were not tried again for almost two millennia.
In China, Hua Tuo was a famous Chinese physician during the Eastern Han and Three
Kingdoms era who performed surgery with the aid of anesthesia.
In the Middle Ages, surgery was developed to a high degree in the Islamic world.
Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab
physician and scientist who practised in the Zahra suburb of Córdoba, wrote medical
texts that shaped European surgical procedures up until the Renaissance.[8][unreliable source?]
In Europe, the demand grew for surgeons to formally study for many years before practicing;
universities such as Montpellier, Padua and Bologna were particularly renowned. Guy de
Chauliac was one of the most eminent surgeons of the Middle Ages. His Chirurgia Magna or
Great Surgery (1363) was a standard text for surgeons until well into the seventeenth century.[9]
By the fifteenth century at the latest, surgery had split away from physic as its own subject, of a
lesser status than pure medicine, and initially took the form of a craft tradition until Rogerius
Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals
up to the modern time. Late in the nineteenth century, Bachelor of Surgery degrees (usually ChB)
began to be awarded with the (MB), and the mastership became a higher degree, usually
abbreviated ChM or MS in London, where the first degree was MB, BS.
Barber-surgeons generally had a bad reputation that was not to improve until the development of
academic surgery as a specialty of medicine, rather than an accessory field.[10] Basic surgical
principles for asepsis etc., are known as Halsteads principles
[edit]Modern surgery
Modern surgery developed rapidly with the scientific era. Ambroise Paré (sometimes spelled
"Ambrose"[11]) pioneered the treatment of gunshot wounds, and the first modern surgeons were
battlefield doctors in the Napoleonic Wars. Naval surgeons were often barber surgeons, who
combined surgery with their main jobs as barbers. Three main developments permitted the
transition to modern surgical approaches - control of bleeding, control of infection and control of
pain (anaesthesia).
Bleeding
Before modern surgical developments, there was a very real threat that a patient would bleed to
death before treatment, or during the operation. Cauterization (fusing a wound closed with
extreme heat) was successful but limited - it was destructive, painful and in the long term had
very poor outcomes. Ligatures, or material used to tie off severed blood vessels, originated as
early as ancient Rome,[12] and were improved by Ambroise Paré in the 16th century. Though this
method was a significant improvement over the method of cauterization, it was still dangerous
until infection risk was brought under control - at the time of its discovery, the concept of infection
was not fully understood. Finally, early 20th century research into blood groups allowed the first
effective blood transfusions.
Pain
Modern pain control through anesthesia was discovered by two American dental surgeons,
Horace Wells (1815–1848) and William T. G. Morton. Before the advent of anesthesia, surgery
was a traumatically painful procedure and surgeons were encouraged to be as swift as possible
to minimize patient suffering. This also meant that operations were largely restricted to
amputations and external growth removals. Beginning in the 1840s, surgery began to change
dramatically in character with the discovery of effective and practical anaesthetic chemicals such
as ether and chloroform, later pioneered in Britain by John Snow. In addition to relieving patient
suffering, anaesthesia allowed more intricate operations in the internal regions of the human
body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.
Infection
Unfortunately, the introduction of anesthetics encouraged more surgery, which inadvertently
caused more dangerous patient post-operative infections. The concept of infection was unknown
until relatively modern times. The first progress in combating infection was made in 1847 by the
Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting
room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule
and opposition, introduced compulsory handwashing for everyone entering the maternal wards
and was rewarded with a plunge in maternal and fetal deaths, however the Royal Society in the
UK still dismissed his advice. Significant progress came following the work of Louis Pasteur and
his advances in microbiology, when the British surgeon Joseph Lister began experimenting with
using phenol during surgery to prevent infections. Lister was able to quickly reduce infection
rates, a reduction that was further helped by his subsequent introduction of the techniques of
Robert Koch (such as the Steam Steriliser, which proved more successful than the carbolic acid
spray that Lister had been using previously) to sterilize equipment, have rigorous hand washing
and a later implementation of rubber gloves. Lister published his work as a series of articles in
The Lancet (March 1867) under the title Antiseptic Principle of the Practice of Surgery. The work
was groundbreaking and laid the foundations for a rapid advance in infection control that saw
modern aseptic operating theatres widely used within 50 years (Lister himself went on to make
further strides in antisepsis and asepsis throughout his lifetime).
[edit]Surgical specialties and sub-specialties

General surgery
Cardiothoracic surgery
Colorectal surgery
Paediatric surgery
Plastic surgery
Vascular surgery
Transplant surgery
Trauma surgery
Breast surgery
Surgical oncology
Endocrine surgery
Skin surgery
Otolaryngology
Gynecology
Oral and maxillofacial surgery
Orthopaedic surgery
Neurosurgery
Ophthalmology
Podiatric surgery
Urology
Some other specialties involve some forms of surgical intervention, especially gynaecology. Also,
some people consider invasive methods of treatment/diagnosis, such as cardiac catheterization,
endoscopy, and placing of chest tubes or central lines "surgery". In most parts of the medical
field, this view is not shared.
[edit]Patronage

The patron saints for surgeons are Saint Luke the Evangelist the physician and disciple of Christ,
Saints Cosmas and Damian (3rd century physicians from Syria), Saint Quentin (3rd century saint
from France), Saint Foillan (7th century saint from Ireland), and Saint Roch (14th century saint
from France).