Timeline of Modern Surgery

Ether as a general anaesthetic was used to extract a tooth by William Morton (1819-1868) in Boston, USA. Two weeks later, on the 16^th of October 1846, Morton successfully anaesthetised a patient for amputation of a leg at the Massachusetts General Hospital in Boston. News spread fast and on the 19^th Dec 1846 Dr Francis Boott (1792-1863) anaesthetised a patient for a tooth extraction using ether in London. Crawford Williamson Long (1815-1878) in Georgia, USA was the first to use ether as a general anaesthetic when he removed a tumour from the neck of a patient. He did not publish until 1848, so by delaying publication he lost primacy to William Morton who was already famous. It must be noticed that information of new procedures was now travelling fast to other lands and continents.

1846. Hand washing.

Ignaz Semmelweiss (1818-1865), in Vienna, recognised that on his maternity ward, where he and his staff attended women in childbirth immediately after carrying out post-mortems led to an 18% mortality among the mothers. Meanwhile the midwives, in the same hospital who had their own maternity ward had a mortality of 2%, not having anything to do with post-mortems. Semmelweiss recognised this and started a regime of rigorous hand scrubbing, using soap and then dipping the hands into chlorinated water before attending a childbirth. As a result maternal mortality in his ward fell to 1%. The cause of puerperal fever was still unknown.

1847. Chloroform

Chloroform first used as a general anaesthetic by Sir James Young Simpson (1811-1870) a Scottish obstetrician.

1850. Thyroidectomy for goitre.

Theodor Kocher (1841-1917) collected records of 146 thyroidectomies for goitre caused by hypothyroidism, between 1850 and 1870. Operative mortality was 21%.

1854-1855. Anaesthesia.

The Crimean War was the first war where the wounded benefitted from anaesthesia.

1856. Anatomy.

The publication of the first edition of Anatomy: Descriptive and Applied, in later editions the title was shortened to Gray’s Anatomy.

1858. Micro-organisms discovered.

Louis Pasteur (1822-1895) published a paper showing that yeast was responsible for the anaerobic fermentation of sugar into alcohol and then later that contaminating micro-organisms were responsible for turning beer, wine and milk sour. In 1862 he showed, in the process that became known as ‘Pasturisation’, that heating these liquids would kill most microorganisms.

1860. Nursing.

Following her work during the Crimean War of 1854-1855, Florence Nightingale (1810-1910) founded the Nightingale School of Nursing at St Thomas’s Hospital and is considered one of the founders of modern nursing.

1862. Germ theory of disease

Louis Pasteur showed in elegant experiments that it was contamination by ‘particles in the air’ that caused unwanted fermentation of liquids including milk. This supported the germ theory of disease and ended the doctrine of spontaneous generation of micro-organisms.

1865. Antisepsis in surgery.

Joseph Lister (1827-1912) was aware of Louis Pasteur’s work and was stimulated to develop a method of using carbolic acid as an antiseptic during operations to amputate limbs with compound fractures. He sprayed carbolic acid on the instruments, dressings and the wound throughout the procedure to kill bacteria. He also insisted on the washing of hands, clean gloves and clean surgical garments. The age of antisepsis had arrived and now most wounds were healing cleanly without sepsis by first intention. It took twenty years before Lister’s methods were followed by the majority of surgeons. Comment by author. In the pre- anaesthesia era, the necessity of speed while operating was essential to keep the high operative mortality due to the inevitable pain and shock to the minimum. With general anaesthesia surgeons now had the luxury of time for measured and careful operating. This coupled with the recognition that postoperative deaths, often caused by bacterial infection, could now be significantly reduced by using the antiseptic method of operating. These advances resulted in an explosion of novel operations over the next few decades, as the three great body cavities of the abdomen, thorax and cranium, could now be entered and complex operations carried out. (Author)

ABDOMINAL, THORACIC and CRANIAL Operations and other Advances in SURGERY

1867. Cholecystostomy

Cholecystostomy in two stage by John Thudichum (1829-1901) in Indianapolis, USA. 1. through small laparotomy incision he fixed the gallbladder to the abdominal wall. 2. When adhesions had formed opened the gallbladder and extracted the gallstones.

1869. Nephrectomy

A planned operation was carried out by Gustav Simon (1824-1876) for a patient with a utero-vaginal fistula.

1871. Oesophagectomy

In Vienna by Theodor Billroth (1829-1894).

1871. Intussusception of bowel

Intussusception of bowel was first successfully reduced at laparotomy by Jonathon Hutchinson (1828-1913), London Hospital, surgeon and medical polymath. This condition mainly occurring in children was usually fatal until Hutchinson popularised this simple operation.

1874. Skin grafts

Karl Thiersch (1822-1895), Professor of surgery in Leipzig, Germany described his method.

1877. The electric cystoscope

Patented by Max Nitze (1848-1906). This revolutionised the treatment of bladder stones and tumours.

1879. Colectomy

First successful resection of colonic cancer with end to end anastomosis was by Vincenz Czerny (1842-1916) Professor of Surgery at Heidleberg, formerly an assistant to Theodor Billroth. By 1899 the number of reported resections was 57 with a 37% mortality mainly due to peritonitis caused by leakage or necrosis at the suture line. By 1895 a staged resection of a colonic carcinoma was developed; in the first stage the tumour was exteriorised outside the abdomen, then later resected forming a double barrelled colostomy and finally the double barrelled colostomy was closed. Mortality was reduced to 12.5%. This operation was later reduced to two stages.

1879. Aseptic method

The Aseptic method of conducting surgical operations with sterilised instruments and drapes was gaining ground and replacing the antiseptic method.

1879. Meningioma resection

The first successful resection of an intracranial tumour was by Sir William Macewen (1848-1924), Regius Professor of Surgery, Glasgow University.

1880. Appendicectomy

by Robert Lawson Tait (1845-1899) of Birmingham on a patient who presented with a right iliac fossa mass. This was not published until 1890.

1880 Nephro-lithotomy

Nephro-lithotomy was first performed by Sir Henry Morris (1884-1926). The diagnosis of the presence of renal calculi was entirely clinical (as the X-ray had not been discovered).

1881. Gastrectomy

First successful resection for carcinoma by Theodor Billroth in Vienna.

1882. Cholecystectomy

Cholecystectomy was first performed by William S. Halsted (1852-1922) at Johns Hopkins Hospital in Baltimore, USA.

1883. Fallopian tube

Fallopian tube, excision for ruptured ectopic pregnancy, as an emergency procedure was performed by Robert Lawson Tait (1845-1899) of Birmingham, England. Before this, rupture of a fallopian tube due to pregnancy was almost invariably fatal.

1886. Prostatectomy

Prostatectomy. The first elective operation using the suprapubic approach for excision of the middle prostatic lobe. By William Bellfield (1856-1929) of Cook County Hospital, Chicago.

1887. Nephrectomy

Nephrectomy, partial, for renal carcinoma by Vincenz Czerny. (1842-1916) Professor of Surgery at Heidleberg, Germany.

1887. Acute appendicitis

Acute appendicitis correctly diagnosed and successfully operated on by Thomas Morton (1835-1903) of Philadelphia, USA.

1889. Common Bile duct surgery

Common Bile duct surgery. Laparotomy and removal of stones from the common bile duct by Robert Abbe (1851-1928), in New York, USA and the a few weeks later by J Knowsley Thornton (1845-1904), in London.

1890. Thyroidectomy for hyperthyroidism

Thyroidectomy for hyperthyroidism. Charles Mayo (1865-1939) in Rochester Minnesota, carried out his first thyroidectomy for hyperthyroidism. George Crile (1864-1943) founder of the Cleveland Clinic, Ohio USA, recognised the high mortality following this operation and heavily sedated his patients for several days before operating. Potassium iodide then began to be used for several days before an operation and the operative mortality fell to 1%.

1893. Splenic excision

Splenic excision, as an emergency operation, following blunt trauma was first successfully undertaken by Oskar Rienger (1844-1910) Surgeon at All Saints Hospital, Breslau.

1893. Saline infusion

Saline infusion was used to replace fluid and blood loss during an operation by injecting saline subcutaneously into the limbs. Oskar Reinger (1844-1910).

1894. Gastric ulcer

First successful, published operation, for a perforated ulcer was by Thomas Herbert Morse (1877-1921) of Norwich, England. The operation to suture a perforated ulcer rapidly became widespread.

1895. Spleen

First successful diagnosis of and then operation for delayed rupture of the spleen by Sir Charles Alfred Balance (1865-1936) at St Thomas’s Hospital, London.

1895. Pneumonectomy for tuberculosis

1895. The first successful pneumonectomy was by Sir William Macewen (1848-1924).

1895. Prostatectomy (total)

Prostatectomy (total) by a suprapubic transvesical approach by Eugene Fuller (1858-1930) of New York. This operation was popularised by Sir Peter Freyer (1851-1921) St Peter’s Hospital London.

1895. X-rays

X-rays discovered by Wilhelm Roentgen (1845-1923), Professor of Physics in Germany, were presented to the local medical society on the 28^th December.

1896. First clinical X-ray

First clinical X-ray taken by Alan Campbell Swinton (1863-1930), a Scottish consulting electrical engineer.

1897. Gastrectomy (total)

Gastrectomy (total) for cancer. Following excision of the stomach the duodenum was closed and a loop of small bowel anastomosed to the oesophagus. Carl Schlatter (1864-1934) of Zurich.

1897. First repair of a gunshot wound

First repair of a gunshot wound to the femoral artery was carried out by J B Murphy (1857-1916), using a continuous suture.

1899. Surgical gloves

Rubber gloves introduced by William Halsted (1852-1922) to protect the hands of the surgeon and scrub nurse from the corrosive properties of the antiseptic solution. The wearing of sterile gloves during an operation gradually became the norm.

1901. First Laparoscopic procedure

Dimitri Oscarovic Ott (1855-1929) was an obstetrician in St Petersburg and a pioneer of transluminal endoscopic surgery when he inspected the abdominal cavity of a pregnant woman.

1902. Saline infusions

Electrolyte imbalance and hypovolaemic shock were now better understood and saline was then mainly used to replace blood and fluid losses during surgery.

1903. Sigmoid colectomy

Sigmoid colectomy for acute diverticulitis by James Rutherford Morrison (1853-1939) Professor of Surgery at Durham.

1907. Rectal carcinoma

Rectal carcinoma excised electively by abdominal approach to form a loop colostomy and then either immediately, or after a delay of days, by a perineal approach. J P Lockhart-Mummery (1875-1957), St Mark’s Hospital, London. This became known as the 'abdomino-perineal' excision of the rectum.

1907. Pyloric stenosis

Pyloric stenosis in infants first treated with a pyloromyotomy by Pierre Fredet (1870-1946) at the Piete Hospital in Paris. He left the mucosa intact but re-sutured the muscle. The operation was simplified in 1911 by Conrad Ramstedt (1867-1963) a German military surgeon who divided the thickened muscle at the pylorus without opening the mucosa and left the incision of the muscle of the pylorus open. The operation is still named ‘Ramstedt’s operation’.

1908. Diathermy (electro-coagulation)

Diathermy (electro-coagulation). The word was coined by Carl Franz Nagelschmitd (1875-1952) who first carried out extensive experiments on patients using diathermy and published a book in 1913.

1909. Resection of duodenum and partial pancreatectomy

Walther Kausch (1867-1928) Professor of surgery in Berlin in a four hour operation, after excising the duodenum and part of the head of the pancreas, he then restored continuity by anastamosing the jejunum to the gastric pylorus and the common bile duct also to the jejunum. In addition he anastomosed the gallbladder to a separate roux-en-y loop of jejunum.He had previously worked for Johannes von Mikulicz (1850-1905), famous for his intestinal surgery.

1912. Vagotomy

The first trans-thoracic truncal vagotomy was carried out by A. Exner in an attempt to alleviate the severe abdominal pain of a tabetic crisis, occurring in a patient suffering from quaternary syphilis, a disease that was then common. (Syphilis can cause demyelination of nerves including the sympathetic and parasympathetic nerves).

1914-1918. World War 1.

High velocity missiles and bacterial contamination of wounds were the norm in Belgium and Northern France. Gas gangrene due to clostridia, a spore forming anaerobic bacillus, was commonplace as also was tetanus. The best treatment for all wounds was extensive debridement and removal of all foreign bodies. Abdominal Surgery. In 1915 Owen Richards carried out laparotomies on patients with gunshot wounds and resected perforated small bowel with success. As a result, between 1915 and 1917, 3520 abdominal operations were carried out by British surgeons with a mortality of 53%, this must be compared with the 100% mortality in the first year of the war when laparotomy was not performed. Intra-cranial surgery. Harvey Cushing (1869-1939), American surgeon, pioneered the removal of missiles lodged in the brain. Arterial bleeding was surgically treated with ligation, if this was in a limb it almost inevitably led to amputation. Blood transfusion. Sir Geoffrey Langdon Keynes (1887-1982). Surgeon at St Bartholomew’s Hospital, London. During World War One served with the British Expeditionary Force in France. He devised a blood flask and transfused a number of the severely wounded who were suffering from exanguination due to massive haemorrhage and were not expected to survive. He achieved gratifying results. Transfusion of blood was very sporadically used in the early years of the war, however by the end of World War One blood was taken from donors and citrated ready for use before major actions. Plastic surgery, as a specialty, was developed during WW1. Led by Harold Delf Gillies (1882-1960), a New Zealander in the RAMC, (Royal Army Medical Corps), an ENT surgeon by training who set up a special unit in Aldershot, England where starting from scratch he invented and used a tubed pedicle grafts to replace missing facial tissue. He also used bone grafts. (The work of the ancient surgeons had been lost). A History of Surgery by Harold Ellis. 2001 ISBN 1 84110 023 4.

1919. Anaesthesia

Sir Ivan Whiteside Magill (1888-1986) an Irishman, originally a general practitioner, accepted a post as anaesthetist in Harold Gillies department of plastic surgery and with Stanley Rowbothom (1890-1979) developed the naso-tracheal technique of intubating the trachea, so enabling the surgeon free access to the mouth.

1920. Urology

Urological Section of the Royal Society of Medicine’s first president was Sir Peter Freyer (1851-1921) who in his inaugural address noted that urology was becoming a distinct speciality in its own right. The first hint of subspecialisation as all surgeons who only practiced urology in the UK at that time were trained general surgeons.

1925. Parathyroidectomy

Felix Mandel (1892-1957) of Vienna was the first to electively excise a parathyroid adenoma in a patient with advanced osteitis fibrosa cystica associated with fatigue and muscle weakness. The existence of the parathyroid gland had been made by Sir Richard Owen (1804-1892) in 1862 in a rhinoceros, he was the conservator at the Royal College of Surgeons in London.

1926. Meningioma

First operation on a very vascular brain tumour using diathermy (electro-coagulation) to control bleeding was carried out by Harvey Cushing (1869-1939), Surgeon-in-Chief at the Peter Bent Brigham Hospital in Boston, USA. Cushing was the founder of modern neurosurgery.

1927. Angiography

Angiography was developed by Egas Moniz, (1874-1955), a neurologist of Lisbon, Portugal in order to provide contrasted x-ray cerebral angiography.

1935. Sulphonamide

The aniline dye Prontosil was found by Gerhardt Domagk (1895-1964) of Germany to be effective against streptococcal infections which untreated carry a high mortality. It was used during the Spanish Civil War and World War Two.

1935. Heparin

First clinical trials were undertaken in Canada and showed it was safe and effective blood anticoagulant. It was not until the early 1990s that an anticogulant was used routinely, on bed-bound patients in hospital, especially before and after surgery, to reduce deep vein thrombosis and fatal pulmonary embolus following an operation.

1936-1939. The Spanish Civil War

Debridement of wounds. In addition to battle wounds there were massive civilian casualties for the first time in the West. Professor Joseph Trueta (1897-1977) a Spanish surgeon at Barcelona demonstrated the benefit of meticulous removal of all dead tissue from a wound the packing it with gauze and if a limb immobilising it.

1939-1945. World War 11

It was the care of the wounded that was that advanced during this war, consolidating what had been learned in WW1. Blood transfusion. The Red Cross organised a register of blood donors. By 1939 citrated blood had a useful shelf life of two weeks if refrigerated, dried plasma was also available. Sir Lionel Whitby (1895-1956), a British haematologist organised a service to make available regular supplies of blood to both the RAMC (Royal Army Medical Corps) and civilian hospitals from the beginning of the war. Casualty Clearing Stations were placed as close to a battle as possible for rapid evaluation of the wounded and first line treatment. Debriding and cleaning wounds, immobilisation of fractures limbs, emergency surgery for abdominal, chest and head wounds. These actions reduced the mortality from abdominal wounds by nearly 50% compared to the First World War and as the war progressed the American figures improved further. This was due to the reduction in the time it took for the wounded to reach a fully equipped surgical unit. Penicillin. Howard Florey (1898-1968) Professor of Pathology at Oxford University and Ernst Chain (1906-1979) a biochemist also at Oxford, followed up the 1929 discovery of penicillin by Alexander Fleming (1881-1955) Pathologist at St Mary’s Hospital, London. By 1940 they had enough penicillin to prevent infection in mice infected with an otherwise lethal dose of Staphylococcus aureus. In 1941 the USA joined the Allies in World War Two and American pharmaceutical companies undertook the manufacture of penicillin. Topical treatment was available during the Allied invasion of Sicily in 1943, however with the Normandy landings in 1944 the Allies took with them a million doses of penicillin for intra-muscular injection. Vascular Surgery. DeBakey and Simeone in their analysis of 2,471 vascular limb injuries recorded a 50% amputation rate and repair of the artery was only attempted in 3% of cases.

1942. Muscle relaxants

Harold Randall Griffith (1894-1985), anaesthetist in Montreal used curare (Chondrodendron tormentosum) on a young man undergoing appendicectomy. For the first time an anaesthetist was able to produce complete muscle relaxation in a patient under general anaesthetic. Curare is used as a poison on arrow-tips by the Indians of South America. Also in 1942, D-tubocurarine a mono-quaternary alkaloid was isolated from Chonodendron tomentosum, a purified and safer muscle relaxant. (NOTE. The author as a student in 1966 when assisting at abdominal operations noted that the effect of the muscle relaxant sometimes wore off before the abdomen was closed. The abdominal muscles went into spasm and the intestines were forcibly extruded out of the abdominal cavity making the closure of the abdominal wall extremely difficult. This difficult closure was not infrequently followed by dehiscence, the wound reopening, several days later and requiring resuture).

1943. First vagotomy

First vagotomy for chronic peptic ulcer disease causing severe scarring and narrowing of the duodenum, resulting in persistent vomiting. Lester Reynold Dragstedt (1893-1975) USA and F.M. Owens carried out a trans-thoracic division of the vagus nerves. Complete division of these nerves will prevent the parietal cells of the gastric lining from producing acid. In the absence of acid the ulcer will heal. The vagus nerve also carries the motor fibres to the stomach causing paralysis and vomiting. To prevent this, by 1947, a gastro-enterostomy was made at the same operation to drain the stomach directly into the small bowel. 'The End of the Golden Age of General Surgery' by N K Maybury. ISBN: 1499531370. Amazon.

1944. Era of cardiac surgery

Era of cardiac surgery began in this year. Alfred Blalock (1899-1964) an American surgeon, with the assistance of Vivien Theodore Thomas (1910-1985), an African-American surgical technician developed the procedures used to treat ‘blue baby syndrome’. The operation became known as the ‘Blalock-Thomas-Taussig shunt operation’ designed to bypass the pulmonary artery stenosis element of a congenital abnormality of the heart known as Fallot’s tetralogy (Helen Brook Taussig (1898-1986) an American paediatric cardiologist) . The operation was carried out in a fifteen-month old baby with this congenital anomaly. A right-subclavian artery to pulmonary artery shunt was carried out that enabled the baby’s arterial blood to be oxygenated. The main research to do this had been carried out over the previous two years by Vivian Thomas. Blalock with Edwards Park also developed a bypass operation for coarctation of the aorta in 1944.

1946. Modern anaesthesia

Modern anaesthesia comes of age giving a patient under anaesthetic the triad of narcosis, analgesia and muscle relaxation and is still used today.

1946. Nuclear medicine

Sam Seidlin published a paper describing successful treatment of a patient with thyroid cancer metastases using radioiodine. This use expanded to enable imaging of the thyroid gland and quantification of the gland's function. Radio-iodine became the standard treatment for hyperthyroidism by the end of the twentieth century.

1948. Correction of transposition of the great blood vessels of the heart

Alfred Blalock (1899-1964) created a technique for overcoming another congenital defect, the transposition of the great blood vessels of the heart. In teaching and in research he paved the way for a new generation of surgeons

1950-1953. Korean War

Wounded rapidly transported by helicopters to a MASH (Mobile Army Surgical Units). With helicopters the time from being wounded for a casualty to reach a MASH still averaged nine hours. Vascular Surgery. In 1950 the US army medical policy was to ligate arteries in wounds if a simple end to end anastomosis was not possible. Before April 1952 ligation of major arteries was routine. In 1958 Carl W Hughes analysed the results of 304 major vessel injuries after April 1952 to the end of the war of which 269 were repaired. Vein or homologous arterial grafts were carried out in 82 cases of which 20 came to amputation. The new specialty of vascular surgery was born. References. Annals of Surgery. Carl W Hughes. 1958 April; 147(4): 555-561. Annals of Vascular Surgery. Michael S. Baker. May 2016, Vol.33:258-262, doi: 1016/j.avsg.2016.01.010. DeBakey, M. D. and F. A. Simeone: Battle Injuries of Arteries in World War 11. Ann. Surg., 123:534, 1946.

1951. Chemotherapy of solid tumours

Jane C Wright (1919-2913) cancer researcher and surgeon at New York Medical College, USA, demonstrated that methotrexate could induce remission in breast cancer.

1952. Aortic aneurysm

Aortic aneurysm first replaced with a homograft by D.A. Cooley (1920-) and M.E. DeBakey (1908-2008) in Huston, USA.

1954. Kidney transplant

The skin was among the first tissue to be transplanted and rejection of skin grafts was studied by Sir Peter Medawar (1915-1987) Head of transplantation section at The Medical Research Council laboratories at Harrow, London. The first kidney transplant, took place at Peter bent Brigham Hospital in Boston, USA. The transplant was between identical twins, so avoiding the risk of rejection. By 1974 about 10,000 kidney transplants had taken place using drugs such as Imuran to supress rejection. By 1962 tissue typing was introduced accompanied by cyclosporine as the principle immune-suppressant.

1954-1973. Vietnam War

Paramedics. Even with helicopters, men were dying before they could reach a MASH. The paramedics first in contact with the wounded were taught to keep the wounded alive long enough to reach the surgical unit. The wounded received definitive treatment by: maintaining the airway, needle release of a tension pneumothorax and aggressive anti-shock resuscitation. Time to reach hospital averaged six hours. Vascular Surgery advanced rapidly during this war. Limb amputations fell to 8%. Reliable synthetic grafts became available.

1963. Liver transplant

Liver transplant was first carried out by Thomas Starzl of Denver, USA and although technically successful it was not until 1967 that any patient survived a year. The introduction of cyclosporine, discovered in 1976 and introduced as an immunosuppressant by Sir Roy Calne, Professor of Surgery at Cambridge, enabled surgeons to achieve from the 1980s an 85% one year survival from this complicated operation.

1966. Transplantation of the pancreas

First pancreatic transplant was at the University of Minnesota, Minniapolis USA on Dec 17 1966 by WD Kelly, RC Lillihei, FK Merkel et al.

Clinical Transplantation, Vol 19, Issue 4 August 2995 p. 433-455. Pancreas transplant outcomes for United States (US) and non USA cases as reported to the United Network for organ sharing (UNOS) and the international Transplant Registry (IPTR) as of June 2004. Angelika C Gruessner, David ER Sutherland.

As of Dec 31st 2004, more than 23,000 pancreas transplants have been recorded 17,000+ in USA and almost 6,000 outside USA. An analysis 1988-2002/3 showed progressive improvements in outcome, with pancreas graft transplant survival rates going from 75% at one year 1988/99 to 85% for 2002/2003 simultaneous pancreas kidney transplants. Technical failure reduced from 12 to 6% SPK pancreas kidney cases, 13-8% in PAK pancreas after kidney cases and immunological failure from 7-2%. During this time duct management changed from bladder to enteric drainage. The US patient survival rate was greater than 95%. TAC&MMF remained the dominant maintenance immunosuppressant until 2004.

1967. First heart transplant

First heart transplant by Christiaan Barnard (1922-2001) University of Cape Town, South Africa. The patient died of pneumonia 18 days post-operatively his transplanted heart still functioning.

1957. Bacterial resistance to penicillin

Bacterial resistance to penicillin first noted.

1963. Bariatric surgery

Jejuno-colic shunt operation achieved a bypass of most of the small bowel resulting in weight loss. 'The End of the Golden Age of General Surgery@ by N K Maybury. 2014 ISBN: 1399531370. Amazon.

1972. Endovascular stenting of coronary arteries

Robert A. Ersek of the University of Minnesota patented this new procedure in 1972 following animal studies in 1969. He also developed the first stent-supported porcine valve that can be implanted transcutaneously reducing the necessity for open heart surgery, Reference: Wikipedia.

1974. Chemoradiation for carcinoma of the anus

Up to this time, surgery was the only treatment available, as there was no known efficacious adjuvant treatment for carcinoma of the anus. The standard treatment was an abdomino-perineal excision of the anus, rectum and associated lymph-nodes that resulted in a permanent colostomy, i.e. the same treatment for a low cancer of the rectum. A trial of preoperative radiotherapy with 5F-U and a single dose of mitomycin in three patients who then underwent an abdominoperineal excision of the anus were found not to have any indication of any residual cancer at the time of their operation. (Dis Colon Rectum 1974;17:354-356). By the late 1980s chemo-radiation was becoming the treatment of choice for cancer of the anus and surgery was reserved for those patients who did not respond or developed a recurrence.

1982. Helicobacter pylori

Helicobacter pylori, a gram-negative bacterium in acute infections in the stomach and duodenum was identified as the cause of peptic ulcers by Barry Marshall and Robin Warren in Australia. When treated with antibiotics and proton-pump inhibitors duodenal and gastric ulcers heal. Within ten years of its discovery the then common operation of vagotomy for chronic peptic ulceration had been abandoned. An example of medical treatment rendering an operation obsolete. ('End of the Golden age of General surgery).

1987. Laparoscopic cholecystectomy.

First acknowledged operation was by Philippe Mouret, a French gynaecologist at Lyon. Until this date laparoscopy was in the domain of the gynaecologists. Francois Dubois of Paris immediately borrowed instruments and after animal trials carried out a laparoscopic cholecystectomy in 1988 and reported the results in the USA the next year. Instruments were developed and the operation was being carried out world-wide within ten years. (This is extensively covered in the authors book).

1991. First Endovascular aortic aneurysm repair

By 2010 stenting accounted for 78% of all non-ruptured aortic aneurysm repairs.

1994. Face re-implantation

1994 Sandeep Kaur a nine-year old child had his face ripped off when his hair was caught in a threshing machine in northern India. Parents race to hospital with face in a plastic bag. The surgeon, Abraham Thomas, a microsurgeon, managed to reconnect the arteries and replace the skin. There was some muscle damage and scarring round the perimeter where the skin was sutured. A similar accident In Australia was carried out in 1996.

First partial face transplant (nose and mouth) with cadaveric donor was in Amiens, France in 2005 by Bernard Devauchelle, an oral and maxillarofacial surgeon, Benoit Lengele of Belgium and Jean-Michel Dubernard. This was followed by parial facial grafts in China and France.

First full face transplant was in France 8th July 2010 In Creteil Nr. Paris and included tear-ducts and eyelids

Turkey, France, USA, and Spain in order of total number of face transplants. Professor Peter Butler Royal Free Hospital in London suggested the operation in 2002. Reference :- Wikipedia.

1996. Low molecular weight heparin

Low molecular weight heparin largely replace unfractionated heparin as it produces a more predictable anticoagulant response and was used routinely, on suitable patients, as prophylaxis to avoid deep vein thrombosis and pulmonary embolus with a massive reduction in fatal pulmonary embolism post operatively. Reference. Lawrence Bizer. Arch. Surg. 1969:98(2):165-166. Cooley DA, DeBakey ME. Successful repair of aneurysm of thoracic aorta and replacement by graft. JAMA. 1953;152:673-676.

2008. Bariatric Surgery.

Introduction of laparoscopic bariatric surgery in England: observational population cohort study. (BMJ 2010;342; c4296). Followed 6953 bariatric procedures between 2000 and 2010 with satisfactory results.