Surgical instruments

The earliest surgical operations were probably circumcision (removal of the foreskin of the penis) and trepanation (making a hole in the skull, for release of pressure and/or spirits). Primitive surgical instruments consisted of flint or obsidian knives and saws. Stone Age skulls from around the world havebeen found with holes from trepanning. Primitive people used knives to removefingers, and the ancient Mesopotamian cultures practiced surgery to some degree. Small copper Sumerian knives of about 3000 B.C. are believed to be surgical instruments. The Babylonian Code of Hammurabi of about 1700 B.C. mentions bronze lancets--sharp-pointed two-edgedinstruments used to make small incisions. The Code, however, provided harshpenalties for poor treatment outcomes, so surgery was practiced only sparingly. Likewise, ancient Chinese and Japanese cultures were opposed to cutting into the human body, so surgical instruments were used very little.

By contrast, the ancient Egyptians recorded surgical procedures as early as 2500 B.C. They fashioned sharper instruments with metal and copper, and designed special tools to remove the brain when preparing bodies formummification. The ancient Hindus excelled at surgery. The great surgical textbook, Sushruta Samhita, probably dates back to the final centuries B.C. This work described 20 sharp and 101 blunt surgical instruments,including forceps, pincers, trocars (sharp-pointed instruments fitted with asmall tube), and cauteries (irons to heat and sear tissue), mostly made of steel. The ancient Hindus used lancets for cataract surgery, scalpels to restore amputated noses via plastic surgery, and sharp knives to remove bladder stones. Ancient Peruvians performed trepanation and left behind various obsidiansurgical instruments, including scalpels and chisels. The Greeks practiced surgery, mostly on external parts, using forceps, knives, and probes, among other instruments. Bronze Roman surgical instruments found at Pompeii include ascalpel with a steel blade, spring and scissor forceps, a sharp hook, and shears. Celsus in the first century A.D. described the use of ligatures to tie off blood vessels and reduce bleeding during operations. Galen(130-200) in the second century A.D. gave detailed instructions on the use of surgical instruments.

After ancient times, medical knowledge atrophied, and surgeons fell to a lowly status. In the absence of knowledge about antiseptics, surgery was highly risky, so only the simplest and most urgent operations, such as amputations, were performed. A few physicians sought to spread knowledge of surgical procedures and published texts that illustrated surgical instruments. Among these were the Muslim Spaniard Albucasis (eleventh century--his favorite instrumentwas the cautery), the Germans Fabricius and Scultetus (1600s), and the Britons William Clowes (1591), Peter Lowe (1596), and John Woodall (1639). Most important was the Frenchman Ambroise Paré (1517-1590), the great surgeonof the Renaissance, who revived use of the ligature and invented many surgical procedures and instruments, among the latter being the "crow's beak" to hold blood vessels while tying them off. He also perfected an instrument for cataract removal.

The era of modern surgery began with the introduction of anesthesia and antiseptics/antisepsis in the mid-1800s. Louis Pasteur (1822-1895) suggested sterilizing surgical instruments in 1878, and the American doctor William Halsted(1852-1922) introduced sterile rubber gloves to surgery in the 1890s. The discovery of X rays in 1895 gave surgeons an invaluable diagnostic tool. Refinements in surgery were made possible by the introduction of the operating microscope (microsurgery) in the mid-twentieth century and laser surgery in the 1970s. New uses for or processing of existing materials continually enhances surgical and diagnostic processes: glass in the form of optical fibre is used in the manufacture of the flexible endoscope, a thin tube with light source, camera, and tiny surgical tools that provides visual examination and allows non-invasive surgery through a natural body opening such as the throat or through a tiny incision; NiTi, bonded nickel and titanium, provides strong, biocompatible, and corrosive resistant metal for implantable devices such as the Mitek anchor used in orthopedic surgery; non-magnetic surgical tools utilizingtitanium are durable and lightweight, and compatible with magnetic resonanceimaging; and bendable handles on surgical instruments--which straighten withthe heat of sterilization--allow precision in open-heart surgery.

Increasingly sophisticated technology makes ever-more-precise surgical toolspossible, among them voice-activated operating microscopes and robotic surgical hands: NASA's Technology Commercialized Program unveiled a robotic "brainsurgeon" in June 1997; their "Smart Probe," robotically guided through the brain, uses minute sensors to measure tissue density and blood flow and an endoscope to transmit real-time images and information to the surgeon via adaptable software that literally learns from experience. Also in 1997, the University of California at Berkeley developed a "millirobot" prototype--not yet usedby a surgeon--which enters the body and differentiates between healthy and cancerous tissue. Looking much like a fountain pen, this little robot transmits data to the surgeon who directs the operation from a remote location usinga television console and controls like joy sticks. Researchers predict that by the end of the first decade in the 2000s, surgeons miles away from an accident victim or battlefield casualty will be directing robotic surgery.

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