Imagine needing an operation a couple of centuries ago. A doctor would lead you into a room (not necessarily one in a hospital), ask you to lie down, and start opening you up. No gloves, few (if any) sanitary precautions, and no anesthetic.
Today’s general surgery patients, though, are wheeled into immaculate operating rooms where the general surgeon scrubs thoroughly, wears gloves, and has access to a bevy of tools and anesthetic procedures.
But these changes didn’t happen overnight. It took years of discovery, innovation, and improvement to get to where we are now.
Here’s a quick rundown on some of the important events that show how general surgery, as we know it today, developed over the years.
General Surgery Timeline
1735 – The world’s first successful appendectomy was performed on an 11-year-old boy who swallowed a pin. The pin caused perforations on the boy’s appendix and thus had to be removed. Dr. Claudius Amyand performed the surgery at St. George’s Hospital in London.
1776 – French surgeon, Pillore, attempted to apply the idea of Alexis Littre and performed the first colostomy to create an artificial anus for an obstructed colon. Prior to the operation, the patient was instructed to ingest mercury to try and open up the passage. None of the ingested metal passed through the body.
1809 – The removal of a 22.5 lb. ovarian cyst by Ephraim McDowell is the first elective abdominal operation. His patient, a Ms. Jane Crawford, was thought to be pregnant but after further examination, was discovered to have an ovarian tumor.
McDowell promised to operate on the tumor if she travelled to his house, even if the surgery was risky; and she did. She rode a horse 60 miles to Danville, Kentucky, and underwent the operation there.
1846 – First public use of anesthesia during an operation at Massachusetts General Hospital. The anesthetic was diethyl ether, and it was used to extract a an absessed tooth. Overseas, people were skeptical of using an anesthetic. It was thus referred to as the “Yankee Dodge.”
1867 – First successful elective gallbladder surgery by John Stough Bobbs of Indianapolis. Bobbs removed gallstones from the patient, a 30-year-old lady, in a room he rented out, three floors above a drugstore. He used chloroform as the anesthetic, but took no antiseptic precautions. Despite that, the surgery was a success and the patient was asymptomatic for 40 years after, outliving her surgeon.
1867 – Papers written by Joseph Lister about antiseptic wound treatment were published in The Lancet. The previously held belief was that infections came from unhealthy vapor coming from the wounds themselves, which would concentrate in the air and infect others. Lister was unconvinced. After reading Pasteur’s papers, he speculated that same process that causes fermentation was involved in wound sepsis.
Lister knew that creosote, a category of carbon based chemicals, was used to disinfect sewers. He used that idea for wound sterilization by spraying the wounds with carbolic acid, a poisonous compound that may be used as an antiseptic in dilute solutions.
1881 – First resection of cancer of the pylorus, the opening of the stomach into the duodenum. The procedure was performed by German-Austrian surgeon Theodor Billroth.
1895 – Frank Thomas Paul published his technique to improve colon surgery. Originally, colon surgeries were a three-step procedure: first, the affected loop of the colon was exposed, second, the tumor was removed, and third, the stoma was closed. Paul’s technique reduced it to two steps: first, he exposed the affected area and sutured a glass tube into the areas above and below the tumor, then immediately removed the growth and closed the incision.
Johannes von Mikulicz – Radecki popularized this procedure after showing that this new technique reduced his mortality rate from 43% to 12.5%. The procedure was subsequently named the Paul-Mikulicz operation.
1964 – Dr. Irving Lichtenstein announced new “tension free” procedure for hernia surgery. The new procedure used a mesh that was placed on top of the hernia instead of sutures that caused tension and could cause a tear if pulled. This technique also allowed patients to be put under using only local anesthesia and to resume physical activity almost immediately. Previous hernia surgeries would require a general anesthetic and two months bed rest after.
1985 – First laparoscopic cholecystectomy performed by Dr. Edrich Mühe of Germany. Laparoscopic cholecystectomy is the removal of the gallbladder using laparoscopic techniques wherein a viewing tube (the laparoscope) is inserted into a small cut on the abdomen to assist the surgeon.
2007 – The first transgastric endoscopic cholecystectomy was performed by Dr. Lee Swanstrom in Oregon. The surgery involved removing the gallbladder without making incisions on the skin.. This “scarless surgery” leads to less pain, a shorter recovery time, and a lower risk of infection.
This procedure is known as Natural Orifice Transluminal Endoscopic Surgery, or NOTES. It involves passing surgical tools through natural orifices (mouth, anus, urethra, etc.). The doctor pulls any removed tissue back through the orifice and closes the internal incision.
General Surgery – What’s Next?
Surgical procedures have indeed come a long way, but the improvements are far from over. Minimally invasive surgery is becoming increasingly commonplace, better materials for wound treatment and performing operations are being synthesized, and new surgical methods are being developed to improve or replace current ones.
With all this already available, the intriguing question that follows is: What will the next big surgical breakthrough look like?