The act of performing surgery may be called a surgical procedure or operation, or simply "surgery". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g.
As a general rule, a procedure is considered surgical when it involves cutting of a person's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as
Types of surgery
Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the 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 person's convenience, or to the surgeon's and the surgical facility's availability.
- Semi-elective surgeryis one that is better done early to avoid complications or potential deterioration of the patient's condition, but such risk are sufficiently low that the procedure can be postponed for a short period time.
- Emergency surgeryis surgery which must be done without any delay to prevent death or serious disabilities and/or loss of limbs and functions.
- Based on purpose:
- Exploratory surgery is performed to establish or aid a diagnosis.
- Therapeutic surgery is performed to treat a previously diagnosed condition.
- Curative surgery is a therapeutic procedure done to permanently remove a pathology.
- Cosmetic surgeryis done to subjectively improve the appearance of an otherwise normal structure.
- Bariatric surgery is done to assist weight loss when dietary and pharmaceutical methods alone have failed.
- By type of procedure:
- female circumcision). Replantationinvolves reattaching a severed body part.
- Resection is the removal of all or part of an lymphoid tissues) within a body cavity.
- Extirpation is the complete excision or surgical destruction of a body part.
- Repair involves the direct closure or restoration of an injured, mutilated or deformed organ or body part, usually by
- Grafting is the relocation and establishment of a tissue from one part of the body to another. A flap is the relocation of a tissue without complete separation of its original attachment, and a free flap is a completely detached flap that carries an intact neurovascular structure ready for grafting onto a new location.
- Bypass involves the relocation/grafting of a tubular structure onto another in order to reroute the content flow of that target structure from a specific segment directly to a more distal ("downstream") segment.
- Implantation is insertion of artificial medical devices to replace or augment existing tissue.
- Transplantation is the replacement of an organ or body part by insertion of another from a different human (or animal) into the person undergoing surgery. Harvesting is the resection of an organ or body part from a live human or animal (known as the donor) for transplantation into another patient (known as the recipient).
- By organ system: Surgical specialties are traditionally and academically categorized by the organ, organ system or body region involved. Examples include:
- mediastinal great vessels;
- digestive tractand its accessory organs;
- Vascular surgery — the extra-mediastinal great vessels and peripheral circulatory system;
- Urological surgery — the genitourinary system;
- head and neck surgery when including the neckregion;
- oral cavity, jaws, and face;
- Neurosurgery — the central nervous system, and;
- musculoskeletal system.
- By degree of invasiveness of surgical procedures:
- By equipment used:
- Laser surgery involves use of laser ablation to divide tissue instead of a scalpel, scissors or similar sharp-edged instruments.
- Cryosurgery uses low-temperature cryoablation to freeze and destroy a target tissue.
- electrocauteryto cut and coagulate tissue.
- Microsurgery involves the use of an operating microscope for the surgeon to see and manipulate small structures.
- Endoscopic surgery uses optical instruments to relay the image from inside an enclosed body cavity to the outside, and the surgeon performs the procedure using specialized handheld instruments inserted through trocars placed through the body wall. Most modern endoscopic procedures are video-assisted, meaning the images are viewed on a display screen rather than through the eyepieceon the endoscope.
- Excision surgery names often start with a prefix for the target organ to be excised (cut out) and end in the suffix -ectomy.
- Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the
- 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. For example, rhino- is a prefix meaning "nose", therefore a rhinoplasty is reconstructive or cosmetic surgery for the nose.
- Repair of damaged or congenital abnormal structure ends in -rraphy.
- Reoperation or "redo" refers to a return to the operating theater after an initial surgery is performed to surgically re-address an aspect of patient care. Reasons for reoperation include postoperative complications such as persistent bleeding, development of seroma or abscess, tissue necrosis or colonization requiring debridement, or oncologically unclear resection margins that demand more extensive resection.
Description of surgical procedure
Prior to surgery, the person is given a
Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly.
Staging for surgery
This section needs additional citations for verification. (January 2019)
The pre-operative holding area
The intraoperative phase begins when the surgery subject is received in the surgical area (such as the operating theater or surgical department), and lasts until the subject is transferred to a recovery area (such as a post-anesthesia care unit).
An incision is made to access the surgical site.
Work to correct the problem in body then proceeds. This work may involve:
- excision – cutting out an organ, tumor, 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.
- reduction – the movement or realignment of a body part to its normal position. e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics.
- 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 person'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
- 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.).
- vertebrae connected allowing them to grow together into one piece.
- modifying the
- repair of a fistula, hernia, or prolapse.
- repair according to the laceration.
- 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
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 or reversed, and the person is taken off ventilation and extubated (if general anesthesia was administered).
After completion of surgery, the person is transferred to the
It is not uncommon for surgical drains to be required to remove blood or fluid from the surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading to abscess.
Postoperative therapy may include
The use of
Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure. This "weekday effect" has been postulated to be from several factors including poorer availability of services on a weekend, and also, decrease number and level of experience over a weekend.
Postoperative pain affects an estimated 80% of people who underwent surgery. While pain is expected after surgery, there is growing evidence that pain may be inadequately treated in many people in the acute period immediately after surgery. It has been reported that incidence of inadequately controlled pain after surgery ranged from 25.1% to 78.4% across all surgical disciplines. There is insufficient evidence to determine if giving opioid pain medication pre-emptively (before surgery) reduces postoperative pain the amount of medication needed after surgery.
Postoperative recovery has been defined as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activities. Moreover, it has been identified that patients who have undergone surgery are often not fully recovered on discharge.
In 2011, of the 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $387 billion in hospital costs.
The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals.
Data from 2003 to 2011 showed that U.S. hospital costs were highest for the surgical service line; the surgical service line costs were $17,600 in 2003 and projected to be $22,500 in 2013. For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure. in 2012, mean hospital costs in the United States were highest for surgical stays.
Older adults have widely varying physical health. Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Assessment of older people before elective surgery can accurately predict the person's recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. People who are frail and elderly (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
Surgery on children requires considerations that are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments.
Doctors perform surgery with the consent of the person undergoing surgery. Some people are able to give better
Global surgery has been defined as 'the
In 2015, the Lancet Commission on Global Surgery (LCoGS) published the landmark report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development", describing the large, pre-existing burden of surgical diseases in low- and middle-income countries (LMICs) and future directions for increasing universal access to safe surgery by the year 2030.
In alignment with the LCoGS call for action, the World Health Assembly adopted the resolution WHA68.15 in 2015 that stated, "Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage." This not only mandated the WHO to prioritize strengthening the surgical and anesthesia care globally, but also led to governments of the member states recognizing the urgent need for increasing capacity in surgery and anesthesia. Additionally, the third edition of Disease Control Priorities (DCP3), published in 2015 by the World Bank, declared surgery as essential and featured an entire volume dedicated to building surgical capacity.
Data from WHO and the World Bank indicate that scaling up infrastructure to enable access to surgical care in regions where it is currently limited or is non-existent is a low-cost measure relative to the significant morbidity and mortality caused by lack of surgical treatment.
A key policy framework that arose from this renewed global commitment towards surgical care worldwide is the National Surgical Obstetric and Anesthesia Plan (NSOAP). NSOAP focuses on policy-to-action capacity building for surgical care with tangible steps as follows: (1) analysis of baseline indicators, (2) partnership with local champions, (3) broad stakeholder engagement, (4) consensus building and synthesis of ideas, (5) language refinement, (6) costing, (7) dissemination, and (8) implementation. This approach has been widely adopted and has served as guiding principles between international collaborators and local institutions and governments. Successful implementations have allowed for sustainability in terms of longterm monitoring, quality improvement, and continued political and financial support.
Access to surgical care is increasingly recognized as an integral aspect of healthcare, and therefore is evolving into a normative derivation of human
Woven through the International Human and Health Rights literature is the right to be free from surgical disease. The 1966 ICESCR Article 12.2a described the need for "provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child" which was subsequently interpreted to mean "requiring measures to improve… emergency obstetric services". Article 12.2d of the ICESCR stipulates the need for "the creation of conditions which would assure to all medical service and medical attention in the event of sickness", and is interpreted in the 2000 comment to include timely access to "basic preventative, curative services… for appropriate treatment of injury and disability.". Obstetric care shares close ties with reproductive rights, which includes access to reproductive health.
Surgical treatments date back to the prehistoric era. The oldest for which there is evidence is
Prehistoric surgical techniques are seen in
9,000-year-old skeletal remains of a prehistoric individual from the
In 1982 archaeologists were able to find significant evidence when the ancient land, called 'Alahana Pirivena' situated in Polonnaruwa, with ruins, was excavated. In that place ruins of an ancient hospital emerged. The hospital building was 147.5 feet in width and 109.2 feet in length. The instruments which were used for complex surgeries were there among the things discovered from the place, including forceps, scissors, probes, lancets, and scalpels. The instruments discovered may be dated to 11th century AD.
Ancient and Medieval Greece
Researchers from the Adelphi University discovered in the Paliokastro on Thasos ten skeletal remains, four women and six men, who were buried between the fourth and seventh centuries A.D. Their bones illuminated their physical activities, traumas, and even a complex form of brain surgery. According to the researchers: "The very serious trauma cases sustained by both males and females had been treated surgically or orthopedically by a very experienced physician/surgeon with great training in trauma care. We believe it to have been a military physician". The researchers were impressed by the complexity of the brain surgical operation.
In 1991 at the Polystylon fort in Greece, researchers discovered the head of a Byzantine warrior of the 14th century. Analysis of the lower jaw revealed that a surgery has been performed, when the warrior was alive, to the jaw which had been badly fractured and it tied back together until it healed.
Early modern Europe
There were some important advances to the art of surgery during this period. The professor of anatomy at the
The second figure of importance in this era was
The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe. An important figure in this regard was the Scottish surgical scientist, John Hunter, generally regarded as the father of modern scientific surgery. He brought an empirical and experimental approach to the science and was renowned around Europe for the quality of his research and his written works. Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others, he conducted his own surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans.
He greatly advanced knowledge of
Other important 18th- and early 19th-century surgeons included
Infection and antisepsis
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
Until the pioneering work of British surgeon
Lister continued to develop improved methods of
The use of
Hieronymus Fabricius, Operationes chirurgicae, 1685
John Syng Dorsey wrote the first American textbook on surgery
An operation in 1753, painted by Gaspare Traversi.
- General surgery
- Craniofacial surgery
- Dental surgery
- Oral and maxillofacial surgery
- Orthopaedic surgery
- Hand surgery
- Paediatric (Pediatric)
- Periodontal surgery
- Podiatric surgery
- World Federation of Neurosurgical Societies
- American College of Surgeons
- American College of Osteopathic Surgeons
- American Academy of Orthopedic Surgeons
- American College of Foot and Ankle Surgeons
- Royal Australasian College of Surgeons
- Royal Australasian College of Dental Surgeons
- Royal College of Physicians and Surgeons of Canada
- Royal College of Surgeons in Ireland
- Royal College of Surgeons of Edinburgh
- Royal College of Physicians and Surgeons of Glasgow
- Royal College of Surgeons of England
- Anesthesia – State of medically-controlled temporary loss of sensation or awareness
- ASA physical status classification system – System for assessing the fitness of patients before surgery
- Biomaterial – Any substance that has been engineered to interact with biological systems for a medical purpose
- Cardiac surgery – Type of surgery performed on the heart
- medical coding
- Surgical drain – Tube used to remove pus, blood or other fluids from a wound
- Endoscopy – Procedure used in medicine to look inside the body
- Fluorescence image-guided surgery – medical imaging technique
- Healthcare Cost and Utilization Project (HCUP) – a family of health care databases etc. from the US
- inpatientsurgical procedures medical coding)
- Jet ventilation– Methods of inspiratory support
- List of surgical procedures
- Minimally invasive procedure– Surgical technique that limits size of surgical incisions needed
- Operative report
- Perioperative mortality – Any death occurring within 30 days after surgery
- Physician Assistant– Mid-level health care provider
- Remote surgery – Ability for a doctor to perform surgery on a patient even though they are not physically in the same location
- Robot-assisted surgery – Surgical procedure
- Surgeon's assistant – person who assists with a surgical operation under the direction of a surgeon
- Surgical Outcomes Analysis and Research – Medical research program
- Surgical sieve
- Trauma surgery – Surgical specialty
- Reconstructive surgery – Surgery to restore form and function
- Rheumasurgery– Medical speciality
- WHO Surgical Safety Checklist
- Women in medicine
- Bariatric surgery
- Cardiac surgery
- Cardiothoracic surgery
- Colorectal surgery
- Endocrine surgery
- General surgery
- Oral and maxillofacial surgery
- Orthopedic surgery
- Hand surgery
- Pediatric surgery
- Plastic surgery
- Reproductive surgery
- Surgical oncology
- Transplant surgery
- Trauma surgery
- Vascular surgery
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