Two health-care disciplines merge within the
arena of surgical operations: ANESTHESIAand sur-
gery. Physicians who administer anesthesia are
anesthesiologists (MDs or DOs). Registered nurses
who have advanced practice education and certifi-
cation in anesthesiology are certified registered
nurse anesthetists (CRNAs). Anesthesiologists
may also choose to further specialize in PAINman-
agement care.
Physicians who perform surgical operations are
surgeons, with further designation according to the
surgeon’s subspecialization. For example, a sur-
geon who operates exclusively on structures of the
chest except the HEARTis a thoracic surgeon; a sur-
geon who operates exclusively on the heart is a
cardiac surgeon. A surgeon who operates exclu-
sively on bones and joints is an orthopedic surgeon.
This section, “Surgery,” presents an overview
discussion of the concepts and practices of surgery
and general entries about surgical operations and
their role in diagnosis and treatment of diseases,
congenital anomalies, and injuries. Entries about
specific operations are in the sections that discuss
the relevant body system—for example, the entry
for HYSTERECTOMY (an OPERATION to remove the
UTERUS) is in the section “The Reproductive Sys-
tem” and the entry for CHOLECYSTECTOMY(an oper-
ation to remove the GALLBLADDER) is in the section
“The Gastrointestinal System.”
Surgery Comes of Age
Early documents from diverse cultures provide
evidence that surgery—entering the body for
therapeutic purposes—has long been among the
treatment options of physicians. Ancient
Ayurvedic physicians extracted cataracts, ampu-
tated limbs, delivered babies by CESAREAN SECTION,
drained pus from infected wounds, removed blad-
der stones, and even performed what plastic sur-
geons today call pedicle flap tissue grafts to repair
damaged noses. Greek physicians operated on sol-
diers to repair battle wounds. In Babylonia and
Egypt surgeons were distinct from physicians,
with clearly defined duties and responsibilities.
Toward the end of the 19th century vastly
improved understanding of anatomy (the body’s
structure) and physiology (the body’s functions)
encouraged physicians to explore the intentional
opening of the body to remove tumors and repair
damage such as from injury or disease. Nearly all
of the misconceptions perpetuated through cen-
turies evaporated in the evidence researchers
acquired through scientific study and dissection of
human cadavers. Surgeons boldly ventured into
new territory: the inner body. Unfortunately,
though surgeons had the knowledge their patients
were less than eager to allow its display. Few will-
ingly submitted to the scalpel when the only
escape from pain was a fortuitously well-placed
upper right to the jaw that delivered UNCONSCIOUS-
NESS. As well, more people died of INFECTIONafter
surgery than recovered from the operation.
But in the 20th century two advances in medi-
cine converged to make surgery feasible: antisep-
sis and anesthesia. As a result of these two crucial
developments, today surgery is the treatment ofSURGERY
Surgery is the specialty within the practice of medicine in which its practitioners use instruments, devices, and tech-
niques to repair or remove organs and structures affected by congenital defect, injury, or disease processes. Surgical
operations are invasive—that is, they enter or open the body in some way.
257