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The Evolution of Surgery: From Bare Hands to Robots

Medics in the Making
Dec 25, 20224 min read

By Steve Cingapagu


Although it is now done with specialized equipment and robots, surgery began with life-threatening procedures involving fingernails and teeth. The vast improvement we have reached throughout the surgical field has been a long progress that has taken place over many centuries with various major breakthroughs along the road. This article will explore the origins and development of surgery.


Prehistoric Times

It is believed that surgery in prehistoric times involved the use of fingers, fingernails, and teeth in order to make incisions, clamp, and dilate various tissues; interestingly, modern surgical instruments are designed to perform the same actions that these ancient surgeons did with their teeth and fingers. Trepanned skulls found in France date the practice of surgery back to 6500 BC. Some skulls found had multiple holes in them (not counting the eyes and nose) evidencing that the patient may have survived the excruciating procedure.



Ancient Times

Surgery is believed to have been common practice in ancient Egypt, where bronze and copper surgical tools were found in the tomb of Qar, a royal physician. These instruments included knives, hooks, drills, forceps, pincers, scales, spoons, saws and a vase with burning incense. In ancient Greece, limbs were amputated (without anaesthesia) and blood was drawn from boils. In ancient Rome, goitres and polyps were removed, an incredible ability for surgeons of the time.


Middle Ages

Following the formation of the United Barber-Surgeon’s Company in the Middle Ages, English surgeons were able to remove kidney stones and cataracts from the eyes. Herbs or alcoholic drinks would be given to patients either to alleviate pain or to remove consciousness to an extent. However, there was a very high death rate due to a lack of knowledge of sepsis, which often caused death from infection. Imagine having your limbs amputated without anaesthesia; surgery would have been a nightmare for people of the past!


19th Century

It wasn’t until 1846 when Boston dentist William T.G. Morton and his team used sulfuric ether to anaesthetize a man who needed surgery to remove a vascular tumour from his neck. One patient who received the procedure reported feeling some scratching, but no pain at all. ‘Letheon’ was the name given to Morton’s new discovery after the Greek mythological river ‘Lethe’, which was known for erasing painful memories.


However, post-surgery death rates were still around 50%; the cause was not known, and surgeons were baffled. Amid all this chaos and confusion British surgeon Joseph Lister pioneered a significant breakthrough.

Scientists in the 19th Century didn’t understand the importance of hygiene, so hospitals were notoriously unclean. In 1847, Hungarian scientist Ignaz Semmelweis discovered that, if clinicians washed their hands before treating a patient, the death rate from childbed fever had reduced from 10% to less than 2%. However, many scientists ridiculed him and did not recognize his observations. When Joseph Lister became a surgeon in 1861, he was immediately determined to resolve the high death rate. Theorizing that some ‘pollen-like dust’ had settled on the wounds, causing death, he began to work. Influenced by Louis Pasteur’s reports in 1865 and the Carlisle authorities, who treated sewage using phenol, he began experimenting. He tried carrying out his surgical procedures using phenol to treat surgical instruments, spraying phenol aerosol in the air, and, post-procedure, treating wounds with dilute phenol. Deaths sharply dropped from 46% in 1864-66 to 15% in 1867-70, rendering Lister’s experiment successful. He published reports outlining his success and by 1877, deaths had dropped to 5%. Modern operating rooms follow principles based on his findings to ensure aseptic conditions.


20th and 21st Century

The first documented robotic surgery dates back to 1985 when the PUMA 560 was used to perform neurological biopsies; it was observed that the use of the robot allowed for greater precision. Robotic surgery further aids surgeons by allowing for 3D visualization, improved dexterity, better movement and better coordination, all of which are limited during traditional or laparoscopic surgery. This is a relatively new and exciting field and will likely reach new heights as the fields of Robotics and AI continue to develop.



20th and 21st Century

The first documented robotic surgery dates back to 1985 when the PUMA 560 was used to perform neurological biopsies; it was observed that the use of the robot allowed for greater precision. Robotic surgery further aids surgeons by allowing for 3D visualization, improved dexterity, better movement and better coordination, all of which are limited during traditional or laparoscopic surgery. This is a relatively new and exciting field and will likely reach new heights as the fields of Robotics and AI continue to develop.


The journey from bare hands to robots has been one filled with both numerous breakthroughs and incredible pain. From the use of fingernails to make incisions to the development of surgical robots, surgery has come a long way and it is clear that the future of surgery from here on out is unpredictable. Will robotic surgery be in popular use? Will a completely new type of surgery emerge? Surgery is an exciting field which has immense potential and, which has been displayed throughout past developments, can expand in unbelievable ways.


Citations:


Edited by Simoni Shah and Noelle Darts




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