a history of surgery

8/6/2019 a History of Surgery

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HISTORY OFHISTORY OF

SURGERYSURGERYDr. Arvind RaiDr. Arvind RaiAssociate ProfessorAssociate Professor

Dept. of SurgeryDept. of Surgery

GMC BhopalGMC Bhopal


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A SHORT HISTORY OFA SHORT HISTORY OF

MEDICINE:MEDICINE:"Doctor, I have an ear ache."Doctor, I have an ear ache.Doctors responseDoctors response--

2000 B.C.2000 B.C. -- "Here, eat this root.""Here, eat this root."

1000 B.C.1000 B.C. -- "That root is heathen, say this prayer."That root is heathen, say this prayer.

1850 A.D.1850 A.D. -- "That prayer is superstition, drink this potion.""That prayer is superstition, drink this potion."

1940 A.D.1940 A.D. -- "That potion is snake oil, swallow this pill.""That potion is snake oil, swallow this pill."

1985 A.D.1985 A.D. -- "That pill is ineffective, take this antibiotic.""That pill is ineffective, take this antibiotic."

2000 A.D.2000 A.D. -- "That antibiotic is artificial. Here, eat this root!""That antibiotic is artificial. Here, eat this root!"


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INTRODUCTIONINTRODUCTION

Those who forget the past are

condemned to repeat it

Santayana

If I have seen farther thanothers, it was because I was

standing on the shoulders ofgiants.

Sir Issac Newton

Like all other specialties ofLike all other specialties ofscience, the history ofscience, the history ofSURGERY starts with theSURGERY starts with thehistory of mankind itself.history of mankind itself.

Treating injury, deformity orTreating injury, deformity or

wound dressing was thewound dressing was themost important for survivalmost important for survivalin the primitive era.in the primitive era.

Although it was not actuallyAlthough it was not actuallyuntil the later half of the 19until the later half of the 19thth

century that it emerged as acentury that it emerged as arecognized and respectedrecognized and respected

discipline.discipline.


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INTRODUCTIONINTRODUCTION--contdcontd

Surgery is the oldest discipline of medicine.Surgery is the oldest discipline of medicine.

Use of medicaments by the first doctors (Use of medicaments by the first doctors (medicimedici))separated medicine from surgery.separated medicine from surgery.

MedicusMedicus possessed knowledge of diseases andpossessed knowledge of diseases and

application of medicaments.application of medicaments.

A good surgeon had to possess intrinsic manual skillsA good surgeon had to possess intrinsic manual skills

that had much lower esteem.that had much lower esteem.


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As Sir William Osler rightly put it as:As Sir William Osler rightly put it as:

It is astonishing that with how little readingIt is astonishing that with how little reading aadoctor can practice medicine, but it is notdoctor can practice medicine, but it is notastonishing how badly he may do itastonishing how badly he may do it

Similarly Hippocrates,Similarly Hippocrates,Father of MedicineFather of Medicinecontained his view of surgery and surgical horizon incontained his view of surgery and surgical horizon inonly one sentence:only one sentence:

"He who wishes to be a surgeon"He who wishes to be a surgeonshould go to warshould go to war

Celsus elaborated this in his own languageCelsus elaborated this in his own language

INTRODUCTIONINTRODUCTIONcontdcontd


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The 3rd partof Medicine is thatwhichcures by hands.

Itdoes notomitmedicaments & regulated diets [theother

parts of Medicine] butdoes most by hand.

The effects ofthis treatmentare moreobvious thanany

other kind inas muchas in diseases since luck helps much,and the samethings areoften salutory,oftenofno useat

all, itmay be doubted whetherrecovery has been dueto

medicines ortoa sound body or good luck.

Butthatpartof medicine whichcures by hand, it is obvious

thatall improvements comes chiefly from this even if it is

assisted somewhat inother ways Celsus

Celsus, Aulus Cornelius, fl. A.D.

14. His extant work, De re

medicina, consists of eight bookson medicine believed to have

been written c.A.D. 30. His was

one of the first works to be

rediscovered and printed

(Florence, 1478) during the

Renaissance and was very

influential


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But the journey of surgery could progress only as itsBut the journey of surgery could progress only as its

preliminary requirements were met. These were:preliminary requirements were met. These were:

--Knowledge of anatomy.Knowledge of anatomy.

--Methods for hemostasis.Methods for hemostasis.

--Anaesthesia for pain free procedures.Anaesthesia for pain free procedures.

--Methods to achieve antisepsis andMethods to achieve antisepsis andprevention of infections.prevention of infections.


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As gradually these prerequisities were metAs gradually these prerequisities were met

which occurred in the 16which occurred in the 16thth century throughcentury through

the ending decades of the 19the ending decades of the 19thth century thatcentury thatthe surgery acquired its present day face.the surgery acquired its present day face.

The history of Surgery can be arbitraryThe history of Surgery can be arbitrary

divided into following phases ofdivided into following phases ofdevelopment :development :


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BEFORECHRISTBEFORECHRIST The firstsurgical procedures were performed inthe

Neolithic Age (about10,000 to 6000 BC). Trepanning,aprocedure in whichahole is drilled inthe skull torelievepressureonthe brain, may have been performed asearly as 8000 BC.

IntheancientIndia Surgery was atthe forefrontofIntheancientIndia Surgery was atthe forefrontofmedicine. Cutting thenoseas punishment for wrongmedicine. Cutting thenoseas punishment for wrongdoing and other deformities ofthe body created thedoing and other deformities ofthe body created theneed forthereconstructiveor plastic surgery.need forthereconstructiveor plastic surgery.

Althoughthe depthof developmentof surgery intheAlthoughthe depthof developmentof surgery inthedifferentcivilizations was different in spiteofthetraceddifferentcivilizations was different in spiteofthetraceduniformity intheapproachto elementary interventions.uniformity intheapproachto elementary interventions.


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BEFORE CHRISTBEFORE CHRISTcontdcontd

The earliestwritten literatureonThe earliestwritten literatureonSURGICAL discipline is theSURGICAL discipline is theSUSRUTASAMHITASUSRUTASAMHITA,compiled,compiledbyby SusrutaSusruta who is regarded aswho is regarded astheFatherofIndian Surgery.theFatherofIndian Surgery.

Compiled somewhere betweenCompiled somewhere between800BC800BC--400AD, itreveals thatthe400AD, itreveals thattheancientIndians set fractures,ancientIndians set fractures,performed amputations, excisedperformed amputations, excisedtumors,repaired Hernias andtumors,repaired Hernias andexcelled incataractoperationsexcelled incataractoperations

apart from plasticandapart from plasticandreconstructive surgery.reconstructive surgery.

Susruta is even depicted tohaveSusruta is even depicted tohaveperformed bowel anastomosesperformed bowel anastomosesusing antsheads as staples.using antsheads as staples.

PAVED BATHROOM AND BRICKWALL

MOHENJO-DARO (c.3300BC)

SUSHRUTHA, SURGEON OF ANCIENT

INDIA, PERFORMING AN ARTIFICIAL EARLOBE (BY ROBERT ATHOM).


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Susutra described and used morethan 150 surgical instrumentmanyof whichresemble modern surgical

instruments

Divided into incision, excision, scraping,puncturing, probing, extraction, provokingsecretion, and suturing.

Over 100 surgical instruments were described

The hand was the most important instrument

The famous Indianphysician who wrotethe

CHARAK SAMHITA


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BEFORE CHRISTBEFORE CHRISTcontdcontd

Therehave been still earlier evidences ofTherehave been still earlier evidences ofEgyptians being awareof liverabscesses inEgyptians being awareof liverabscesses in4000 B.C.,4000 B.C.,

While peptic ulcer perforations were well knownWhile peptic ulcer perforations were well known

to Romans inabout2000to Romans inabout2000 B.C.B.C.

Butstill atthattime Surgery remained a domainButstill atthattime Surgery remained a domain

ofcraftsmen: barbers and bathofcraftsmen: barbers and bath--attendants.attendants.


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AnArab Surgeon Performing the ancient cataractAnArab Surgeon Performing the ancient cataract

Operation called COUCHING first described byOperation called COUCHING first described by

SUSHRUTHA.SUSHRUTHA.


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FIRST17CENTURIESFIRST17CENTURIES

During this period very littleadvancementwas made inDuring this period very littleadvancementwas made insurgical craft. Surgeons were givena lower status assurgical craft. Surgeons were givena lower status ascompared to physicians by society.compared to physicians by society.

However intheIslamiccountries a Surgeon was givenaHowever intheIslamiccountries a Surgeon was givenamorehonored place.morehonored place.

By the fifteenthcentury barberBy the fifteenthcentury barber-- surgeons routinelysurgeons routinely

served royal courts in Europe.served royal courts in Europe.

Eventhoughthe scopeof surgery atthattime wasEventhoughthe scopeof surgery atthattime waslimited the period saw many remarkableachievements.limited the period saw many remarkableachievements.


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FIRST17CENTURIESFIRST17CENTURIES--contdcontd

Celsus described firstCelsus described first

operation for hernia in earlyoperation for hernia in earlypart of 1part of 1stst century A.D.century A.D.

De re medicina,De re medicina, consists ofconsists ofeight books on medicineeight books on medicinebelieved to have been writtenbelieved to have been writtenc.A.D. 30 by Celsus.c.A.D. 30 by Celsus.


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In 1316 the French surgeon Guy

de Chauliac published Chirurgia

magna (Great Surgery).

This massive text describes howto remove growths, repair

hernias and treat fractures using

slings and weights.

The text helped surgery gain

respect as a serious science.



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At this time a new order of surgeons arose in France.

They were called surgeons of the long robe,distinguished from the barber surgeons who wereknown as surgeons of the short robe.

The barber surgeons had little medical training, whilethe surgeons of the long robe were studied physiciansand considered such practices as bloodlettingprimitive.

Corporations, or guilds, of surgeons of the long robewere formed in several countries.


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In 1559 A.D. acomprehensivetextbook onhernia wasIn 1559 A.D. acomprehensivetextbook onhernia waspublished by Stromayr, in whichhe differentiatedpublished by Stromayr, in whichhe differentiatedbetween indirectand directhernias.between indirectand directhernias.

Frenchroyal barber surgeon Felix cured king Louis XIVFrenchroyal barber surgeon Felix cured king Louis XIV

ofananal fistula.ofananal fistula.

RenDescartes (1596RenDescartes (1596--1650) Philosopherand1650) Philosopherandmathematician gavethemathematician gavethe --

PrincipleofVerification: donotbelieve it if you cannotPrincipleofVerification: donotbelieve it if you cannotprove it.prove it.

Surgery and autopsies becameacceptable,and humanSurgery and autopsies becameacceptable,and humandissection becamecommon (Michelangelo, daVinci)dissection becamecommon (Michelangelo, daVinci)


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FIRST17CENTURIESFIRST17CENTURIES--contdcontd The firstrecorded splenectomy was perfomed by AdrianThe firstrecorded splenectomy was perfomed by Adrian

Zarcaelli in 1549 A.D.Zarcaelli in 1549 A.D.

Howeverthe mainachievements ofthis period were inHoweverthe mainachievements ofthis period were in

understanding ofunderstanding of AnatomyAnatomy-- Andreas Vesalius (1514Andreas Vesalius (1514--1564)1564)

[[ Vesalius's work was revolutionary, as he was among the first toVesalius's work was revolutionary, as he was among the first toperform thorough cadaver dissections himself. He showed thatperform thorough cadaver dissections himself. He showed thatGalen's anatomy was merely an attempt to apply animal structureGalen's anatomy was merely an attempt to apply animal structure

to the human body.to the human body. ]]

HemostasisHemostasis-- Ambroise Pare (1510Ambroise Pare (1510--1590)1590)

Thus thetwo firstprerequisites weremet.Thus thetwo firstprerequisites weremet.


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French surgeon

Ambroise Par, oftencalled the Father ofmodern surgery. Parsuccessfully employedthe method of ligating,

or tying off, arteries tocontrol bleeding, thuseliminating the oldmethod of cauterizing,or searing, the bleeding

part with a red-hot ironor boiling oil.

"I dressed the wound, but God healed him,""I dressed the wound, but God healed him,"

He devised many instrument forcauterisation


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An interesting fact is thatthe BritishAn interesting fact is thatthe British

physicians learned theartof Rhinoplasty,physicians learned theartof Rhinoplasty,oneofthe mostcommon surgeries beingoneofthe mostcommon surgeries beingperformed then by theIndian Surgeons inperformed then by theIndian Surgeons inthe days ofthe EastIndia Company.the days ofthe EastIndia Company.


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PREPRE--ANAESTHETICERAANAESTHETICERA

When people started understanding the pathoWhen people started understanding the patho--physiology of diseases,theneed for surgery was actuallyphysiology of diseases,theneed for surgery was actuallyrealized.realized.

However intheabsenceofanesthesia,asepsis,andHowever intheabsenceofanesthesia,asepsis,andantibiotics the surgery was still primitive.antibiotics the surgery was still primitive.

Ineptattempts attreatmentof incarcerated andIneptattempts attreatmentof incarcerated andstrangulated hernias were made.strangulated hernias were made.

Rudimentary colostomies and ileostomies were made byRudimentary colostomies and ileostomies were made bysimply incising skinoveran expanding intraabdominalsimply incising skinoveran expanding intraabdominalmass,representing the end stageof long standingmass,representing the end stageof long standing

intestinal obstruction.intestinal obstruction.


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PREPRE--ANAESTHETIC ERAANAESTHETIC ERA--contdcontd

In 1716 A.D. Berta did firstsurgical resectionofIn 1716 A.D. Berta did firstsurgical resectionofliver whenheamputated a partof liverliver whenheamputated a partof liver

protruding througha stab wound.protruding througha stab wound.

In 1736 A.D. Claudius Amyand performed firstIn 1736 A.D. Claudius Amyand performed firstappendectomy.appendectomy.

In1770A.D. Littres herniaand inIn1770A.D. Littres herniaand in 1777A.D.1777A.D.Richters hernia were described.Richters hernia were described.


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PREPRE--ANAESTHETIC ERAANAESTHETIC ERA--contdcontd

Inspiteofall theseachievements the scopeofInspiteofall theseachievements the scopeof

surgery was limited becauseabsenceofsurgery was limited becauseabsenceof

anesthesia,antisepsis and antibiotics precludedanesthesia,antisepsis and antibiotics precluded

aa Laparotomy.Laparotomy.


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THE DAY THAT CHANGEDTHE DAY THAT CHANGED

THE FUTURETHE FUTURE

October 16October 16thth 18461846

William T. G. Morton a Boston dentistWilliam T. G. Morton a Boston dentistadministered sulfuric ether to a surgicaladministered sulfuric ether to a surgical

patient to give firstpatient to give first General AnesthesiaGeneral Anesthesia..

Although American surgeon Crawford W. Long used anesthesia in1842 during the removal of tumors but did not publish his resultsuntil 1849.


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1865the British surgeonJoseph Listerapplied Pasteur's work to

surgery, developing antiseptic (germ-killing) techniques includingthe use of a carbolic acid spray to kill germs in the operating

room before surgery. This helped eliminate postoperative

infection.

Other physicians, includingAustrianIgnaz SemmelweissandAmericanOliver Wendell Holmes, determined that bacteria are

also carried on the hands and clothing and transferred from

patient to patient by the physician.

These physicians pioneered simple techniques such as washinghands and changing into clean clothing before surgery that

prevent wound contamination during surgery.


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PREPRE--ANTIBIOTICERAANTIBIOTICERA Withtheavailability ofanesthesiaand asepsis developedWiththeavailability ofanesthesiaand asepsis developed

by JosephLister in laterhalfof 19by JosephLister in laterhalfof 19thth century, surgeonscentury, surgeonspractically explored every partofabdominal cavity.practically explored every partofabdominal cavity.

Among the most importantaccomplishments wasAmong the most importantaccomplishments wasmastering thetechniqueof stomach surgery.mastering thetechniqueof stomach surgery.

The firstsuccessful stomachresection was performed byThe firstsuccessful stomachresection was performed byTheodor Billroth inViennaon January 29th, 1881Theodor Billroth inViennaon January 29th, 1881

[ BILLROTH[ BILLROTH --Iopn.] The patient,a 43Iopn.] The patient,a 43--yearyear--old woman,old woman,Therese Heller survived almost4 months and died forTherese Heller survived almost4 months and died forcancer spread.cancer spread.


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PREPRE--ANTIBIOTICERAANTIBIOTICERA--contdcontd

BillrothBillroth, was first to, was first toperform resection ofperform resection ofstomach with thestomach with the

technique of gastrotechnique of gastro--jejunalanastomosisjejunalanastomosis

BILLROTH II opn. onBILLROTH II opn. onJanuary 15th, 1885.January 15th, 1885.This techniqueis stillThis techniqueis still

being used inavarietybeing used inavarietyof modifications.of modifications.


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Mikulicz performed the firstpyloroplastyMikulicz performed the firstpyloroplastyoperations independently in 1886operations independently in 1886

He invented numerous novel operative solutionsHe invented numerous novel operative solutionswhichhave been widely accepted and used upwhichhave been widely accepted and used uptill now.till now.


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Heoperated ona patientwith perforated pepticHeoperated ona patientwith perforated pepticulcerand commented :ulcerand commented :

""Everydoctor, faced with a perforated ulcerofthestomachEverydoctor,faced withaperforated ulcerofthestomach

orintestine, mustconsideropeningoftheabdomen,sewingorintestine, mustconsideropeningoftheabdomen,sewingupthehole,andavertingapossibleoractualinflammationupthehole,andavertingapossibleoractualinflammation

bycarefulcleansingoftheabdominalcavitybycarefulcleansingoftheabdominalcavity".".

He was thus the firstoneto suturea perforatedHe was thus the firstoneto suturea perforatedulcer.ulcer.


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DrainageofDrainageofAppendicularAbscessAppendicularAbscesssuccessfully doneon King Edwardsuccessfully doneon King Edward

VII in 1902VII in 1902

This eventgainedalotofattentionandSurgeryThis eventgainedalotofattentionandSurgery

gainedaccep

tance i

ndee

dit

became f

ashiona

bleg

ainedaccep

tance i

ndee

dit

became f

ashiona

ble


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The unique discovery ofThe unique discovery ofWilhelm Conrad RoentgenWilhelm Conrad Roentgentruly changed the world andtruly changed the world andimmediately became a usefulimmediately became a usefultool for medical science.tool for medical science.

The introduction ofThe introduction ofradiological examinationsradiological examinationsushered the way to diagnosticushered the way to diagnosticprocedures until then based onprocedures until then based onclinical verificationclinical verification alone.alone.

The discovery of the bloodgroups A, B, and O by Austrianpathologist Karl Landsteiner


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Onenamethat is responsible for bringing

revolution inthe field of surgery is of

William StewartHalsted (1852-1922).

He developed theconceptof sterile modern

operationrooms. He showed thatresearch based onanatomic,

pathologicand physiologic principles and animal

experiments can make itpossibleto develop

sophisticated operative procedures.

He insisted on meticulous and safe dissectionratherthantechnical brillianceand speed.

He broughtthe residencysystemsoftraining

surgeons.



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MODERNAGEMODERNAGE

Introductionofthe Halstedian principles marked thebeginning of modern era inthe field of surgery. Workingwiththese principles initial few decades of lastcenturywere spent in making surgery a fineart from acrudecraft.

Trials were invogueto suggest finerchanges inestablished surgical procedures.

Simultaneously this period saw somerevolutionarydevelopments viz-


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DEVELOPMENT OF ENDOSCOPICDEVELOPMENT OF ENDOSCOPICPROCEDURESPROCEDURES

Firstattempts toview body cavities were madeFirstattempts toview body cavities were madeusing acandle,and then gas burning flameusing acandle,and then gas burning flameallowing fora brighter light.allowing fora brighter light.

Theattempts were unsuccessful duetoTheattempts were unsuccessful duetoinadequate illumination.inadequate illumination.

Inthe early 1900s first lighted telescopes wereInthe early 1900s first lighted telescopes wereused. After Edison's inventionofthe bulb, itwasused. After Edison's inventionofthe bulb, itwasused inthe firstgastroscopeconstructed by Janused inthe firstgastroscopeconstructed by JanMikuliczMikulicz--Radecki (1850Radecki (1850--1905) incollaboration1905) incollaborationwith JosefLeiterwith JosefLeiter


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FirstEndoscopy done by a surgeon Michlich


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In 1901 Kelling used cystoscopeto do firstdiagnostic laparoscopy inacanine model.

Jacobeus performed firstendoscopy inhumansin 1911.

Kalk introduced the dual trochar system in 1929.

Verres invented spring-loaded obturatorneedlefor pneumoperitoneum in 1938.


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Semm developed automatic CO2 insufflator in 1960s.Semm developed automatic CO2 insufflator in 1960s.

First lapaorscopicappendectomy was performed in 1983First lapaorscopicappendectomy was performed in 1983by Semm.by Semm.

First laparoscopiccholecystectomy was performed inFirst laparoscopiccholecystectomy was performed in1987 by Philip Mouret.1987 by Philip Mouret.

FirstLaparoscopic Cholecystectomy inIndia was done byFirstLaparoscopic Cholecystectomy inIndia was done byDr. Tempton E Udewadia.Dr. Tempton E Udewadia.

Guiness book of world record has the fastestGuiness book of world record has the fastestLaparoscopic CholecystectomyLaparoscopic Cholecystectomy 5 minutes inthename5 minutes inthenameofDr. Pradip Chowbey,Delhi a pass outofMedicalofDr. Pradip Chowbey,Delhi a pass outofMedicalCollege JabalpurCollege Jabalpur


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TRANSPLANTATIONTRANSPLANTATION

The modern eraoftransplantationThe modern eraoftransplantationbegan in 1950 withthe knowledgeofbegan in 1950 withthe knowledgeoftechniques foranastomosing bloodtechniques foranastomosing bloodvessels developed byvessels developed by MathieuMathieu

JabouleyJabouley andandAlexis CarrelAlexis Carrel attheatthebeginning ofthe 20beginning ofthe 20thth century.century.

The firstsuccessful transplantwas aThe firstsuccessful transplantwas aKidney transplantdone by JosephKidney transplantdone by JosephMurray etal.atthe Bringham hospitalMurray etal.atthe Bringham hospitalin Boston in 1954.in Boston in 1954.

Tom Starzl performed firsthumanTom Starzl performed firsthumanlivertransplant in 1963.livertransplant in 1963.

Alexis carrel 1873-1945nobel forvascularsuture & organ

transplant


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In 1967,Dr.Christian Bernard performed the firstIn 1967,Dr.Christian Bernard performed the firsthumanhearttransplant in Capetown, South Africa.humanhearttransplant in Capetown, South Africa.

In 1968 Roy Calnerevolutionised theIn 1968 Roy Calnerevolutionised thetransplantation withthe demosntrationofthetransplantation withthe demosntrationoftheimmunosupressive properties of Cyclosporin whichimmunosupressive properties of Cyclosporin whichimproved theresults oftransplantacceptance.improved theresults oftransplantacceptance.

In 1981,the firstever successful combined HeartIn 1981,the firstever successful combined HeartLung transplantwas performed by Dr.BruceReitz.Lung transplantwas performed by Dr.BruceReitz.


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In 1987 FakertBelzer developed University ofIn 1987 FakertBelzer developed University ofWisconsin SolutionWisconsin Solution-- A new Liverand pancreasA new Liverand pancreaspreserving solutionpreserving solution

Researches are under way toovercomethe mostResearches are under way toovercomethe mostimportant limiting factor intransplantation i.etheimportant limiting factor intransplantation i.etheshortageof donors by way of stem cell harvestingshortageof donors by way of stem cell harvestingand genetic engineering.and genetic engineering.

Itwill beno fartheraway whenthe surgeons will beItwill beno fartheraway whenthe surgeons will begetting thereadymadeorgans to makegetting thereadymadeorgans to maketransplantationacommon day to day procedure.transplantationacommon day to day procedure.


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STAPLING DEVICESSTAPLING DEVICES

Preliminary staplers were firstused in early years of lastPreliminary staplers were firstused in early years of lastcentury.century.

Thecredit for developing modern staplers goes to USSRThecredit for developing modern staplers goes to USSRwhere Scientific ResearchInstitute for Surgicalwhere Scientific ResearchInstitute for SurgicalApparatus and Instruments firstdeveloped them inApparatus and Instruments firstdeveloped them in1950s.1950s.

The staplers reached United States in1960s, wheretheyThe staplers reached United States in1960s, wheretheypopularized by U.S. Surgical Corporation.popularized by U.S. Surgical Corporation.


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Hemicorporectomy ortranslumbar amputation isprobably the most mutilatingoperation ever to be describedin surgical literature.

Treatment for pelvic

malignancy First proposed in 1951 and

performed in 1960

Two of the first three patients

died within days of oedema;one survived 19 years

A series of 10 cases reportedfrom New York in 1982


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Modern technologies like digitisationModern technologies like digitisation

& optics, use of radiofrequency,& optics, use of radiofrequency,

LASERS allow for so many more typesLASERS allow for so many more types

of surgeries that werent possibleof surgeries that werent possible

beforebefore

The endoscope is one of themThe endoscope is one of them keykey

hole surgerieshole surgeries

The field is continuouslyThe field is continuously

changingchanging


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ROBOTICS IN SURGERYROBOTICS IN SURGERY

The mostrecentadvance is the useof Robots in Surgery.The mostrecentadvance is the useof Robots in Surgery.Conceptualized by the US Army forthe distantConceptualized by the US Army forthe distantmanagementof warvictims atthe battlefield.managementof warvictims atthe battlefield.

Presently robots are used for performingPresently robots are used for performingprostatectomies,heartsurgeries etc. Itwill be long whenprostatectomies,heartsurgeries etc. Itwill be long whenalmostall the surgeries will be performed by arobotbeingalmostall the surgeries will be performed by arobotbeingmonitored by the surgeon.monitored by the surgeon.

TheGreatLeap of FaithTheGreatLeap of Faith

Surgery withoutphysically seeing ortouching patientsSurgery withoutphysically seeing ortouching patients

Computer is becoming more involvedComputer is becoming more involved Nintendo surgeonsNintendo surgeons

Integrationof Computer Science fortraining purposesIntegrationof Computer Science fortraining purposes

Virtual RealityVirtual Reality


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19851985-- Puma 560Puma 560

19941994-- AESOPAESOP

20012001-- DaVinciDaVinci


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Butherethe story ofthe surgery doesntButherethe story ofthe surgery doesntend,end,

this is jus

ta

mere begi

nning,

this is jus

ta

mere begi

nning,

there is a lotmoretocome;there is a lotmoretocome;

fornoone knows whatthetimeholds infornoone knows whatthetimeholds inhis wrapped hands inthenear future.his wrapped hands inthenear future.


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CystCyst -- short for sistershort for sister DiagnosisDiagnosis -- person with slanted noseperson with slanted nose DilateDilate -- the late British Princess Dianathe late British Princess Diana DislocationDislocation -- this is the placethis is the place DuodenumDuodenum -- couple in blue jeanscouple in blue jeans EnemaEnema -- nota friendnota friend FalseLaborFalseLabor -- pretending to workpretending to work

GenesGenes -- blue de nimblue denim GroinGroin -- to mashtoa pulp/smileto mashtoa pulp/smile HerniaHernia -- she is close byshe is close by HymenHymen -- greetings to several malesgreetings to several males ImpotentImpotent -- distinguished/welldistinguished/well--knownknown Labor PainLabor Pain -- hurtatworkhurtatwork LactoseLactose -- people without feetpeople without feet LymphLymph -- walk unsteadilywalk unsteadily MicrobesMicrobes -- small dressing gownssmall dressing gowns


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Good surgeons know how toGood surgeons know how tooperate, better surgeons whentooperate, better surgeons whentooperate,and the bestwhennottooperate,and the bestwhennottooperate.operate.

Is there anybody less evidenceIs there anybody less evidencebased than surgeons?based than surgeons?

YesYesPoliticiansPoliticians

ManagersManagers

EditorsEditors


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THANK YOUTHANK YOU

SCHEDULE FOR INTERNAL ASSESSMENT EXAMINATIONS


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SCHEDULE FOR INTERNAL ASSESSMENT EXAMINATIONS

S.

NoName of

examination

Marks Timing of

examination1. Ward leaving test-I 40 II Prof.(4th semester)

2. First sessional exam. 100 Final prof. part-I(6TH

semester)

3. Ward leaving test-II 40 Final prof. part-II(8TH or9th semester)

4. Second sessional exam. 160 Final prof. part-II(8TH

semester)

5. Preuniversity exam. 160 Final prof. part-II(9TH

semester)

Total Marks-500NOTE-75% attendance is must for eligibility of ward leaving

a history of surgery

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