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).
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. Asemi-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.
Modern surgery developed rapidly with the scientific era. Ambroise Paré (sometimes spelled “Ambrose”) pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the Napoleonic Wars. Naval surgeons were oftenbarber 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, 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 andchloroform, 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 theHungarian 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.
- Before any surgery it is very important to build up the immune system and fucoidan in a suspended gel can provide the best natural form of bioavailability. Infections have been reduced during surgical procedures of course but no room is sterile to the point that infections will be eliminated. With that stated, taking fucoidan to boost the immune system is also critical following any surgery because surgeries entail exposing the body when cut to the elements within the room the surgical procedure is being performed. UMI with fucoidan as an immune system enhancer should therefore be ingested before and after any surgery – for a few days before and for several days after surgery.
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