Surgery

Surgery can be used to repair broken bones, stop uncontrolled bleeding, remove injured or diseased tissue and organs, and reattach severed limbs. Exploratory surgery helps physicians diagnose conditions that cannot be detected by traditional tests. It allows for examination of internal organs for signs of disease.

People have practiced surgery since ancient times, but it did not become a respected science until the 19th century. Increasing knowledge of the human body, the discovery of anaesthesia (a loss of physical sensation that can be induced with drugs), and the use of germ-free, or sterile, operating procedures combined to make surgery a safe and effective method of medical treatment. In the 20th century advances in technology have helped the field of surgery grow at a rapid pace. Surgical procedures are classified as optional, required, elective, urgent, and emergent based on the patient’s medical condition. Optional surgery consists of operations that are not required but which the patient chooses to undergo as with some types of cosmetic surgery. Required surgery is performed when only surgery will correct a problem—such as cataracts—but the surgery can be delayed for a period of weeks or months. Elective surgical procedures usually involve conditions that may not require surgery but in which surgery will have a favourable effect—such as the removal of a small cyst. Urgent surgical procedures are performed when a patient’s condition is not immediately life threatening, but failure to treat it may result in death. Patients with some form of cancer are often considered urgent surgical cases. Emergency procedures must be performed within a few hours of a patient’s arrival at a hospital to prevent death. These surgeries correct serious life-threatening conditions such as major wounds, blockages of the intestines, or appendicitis—inflammation of the appendix.

For any surgical procedure, medical care is provided before (preoperative), during (intraoperative), and after (postoperative) the operation. Preoperative care includes routine checks of vital signs including temperature, pulse, and blood pressure; analysis of blood and urine; and physical examination to evaluate organ function. An anaesthesiologist (a physician trained to provide anaesthesia) looks for signs that might make the administration of anaesthetics dangerous such as chest infections or low blood pressure. A history of the patient’s use of medications is acquired to prevent possible adverse interactions with anaesthetics. A surgeon will generally counsel the patient and his or her family about the surgery and what to expect after the operation is performed. Preoperative care reduces the risk of complications during and after surgery.

Intraoperative care involves several members of the surgical team. The surgeon determines the timing of the operation, the techniques, and the instruments and supplies to be used. The anesthesiologist controls the patient’s pain and, if necessary, the level of unconsciousness to make surgery more tolerable and ensure that the patient regains consciousness safely and quickly following the operation. The scrub nurse readies all instruments, ensures the sterility of the surgical field, and anticipates when instruments will be needed by the surgeon. The circulating nurse makes sure the operating room is adequately supplied and provides any additional supplies to the scrub nurse during the operation. Depending upon the hospital, surgical assistants, physician assistants, surgical residents, medical students, and nursing students may also attend an operation.