Sunday, May 30, 2010
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Renaissance and after
In the Renaissance and post-Renaissance era, new instruments were again invented and designed, in order to accompany the increased audacity of surgeons. Amputation sets and specialized instruments such as catlins originated in this period, due to the increased severity of war-inflicted wounds by shot, grapnel and cannon.
However, it was only with the discovery of anesthesia and surgical asepsis that new surgical instruments were invented to allow the penetration of the inner sanctum, or the previously forbidden body cavities, namely the skull, the thorax and the abdomen. A veritable explosion of new tools occurred with the hundreds of new surgical procedures which were developed in the 19th century and first decades of the 20th century. New materials, such as stainless steel, chrome, titanium and vanadium were available for the manufacturing of these instruments. Precision instruments for microsurgery in neurosurgery, ophthalmology and otology were possible and, in the second half of the 20th century, energy-based instruments were first developed, such as electrocauteries, ultrasound and electric scalpels, surgical tools for endoscopic surgery, and finally, surgical robots.
Historically, the development of a surgical instrument follows:
The surgeon uses a common tool and/or adapts it for use in an operation. Some ancient sources of such tools are weapons, butcher's tools, items used in ritual body modification, cannibalism or torture, carpenter's, leather worker's and metal worker's implements. (This process still continues, with tools coming out of automobile shops, aerospace workplaces, kitchens, etc.)
There is a period of transference and incremental improvement, generally focusing on materials, which must be nontoxic and durable. Blood tends to corrode and the repeated washing and sterilization of surgical instruments tends to quickly destroy many materials; other materials hold stains and bacteria.
There is a period of standardization.
However, in modern times, surgeons are also designing instruments from scratch. Also, governmental controls have modified the path of innovation somewhat.
Recent times has seen a move away from reusable instruments to single-use, disposable instruments. Advances in tooling have led to low-cost all-metal tools of similar construction to the permanent version
However, it was only with the discovery of anesthesia and surgical asepsis that new surgical instruments were invented to allow the penetration of the inner sanctum, or the previously forbidden body cavities, namely the skull, the thorax and the abdomen. A veritable explosion of new tools occurred with the hundreds of new surgical procedures which were developed in the 19th century and first decades of the 20th century. New materials, such as stainless steel, chrome, titanium and vanadium were available for the manufacturing of these instruments. Precision instruments for microsurgery in neurosurgery, ophthalmology and otology were possible and, in the second half of the 20th century, energy-based instruments were first developed, such as electrocauteries, ultrasound and electric scalpels, surgical tools for endoscopic surgery, and finally, surgical robots.
Historically, the development of a surgical instrument follows:
The surgeon uses a common tool and/or adapts it for use in an operation. Some ancient sources of such tools are weapons, butcher's tools, items used in ritual body modification, cannibalism or torture, carpenter's, leather worker's and metal worker's implements. (This process still continues, with tools coming out of automobile shops, aerospace workplaces, kitchens, etc.)
There is a period of transference and incremental improvement, generally focusing on materials, which must be nontoxic and durable. Blood tends to corrode and the repeated washing and sterilization of surgical instruments tends to quickly destroy many materials; other materials hold stains and bacteria.
There is a period of standardization.
However, in modern times, surgeons are also designing instruments from scratch. Also, governmental controls have modified the path of innovation somewhat.
Recent times has seen a move away from reusable instruments to single-use, disposable instruments. Advances in tooling have led to low-cost all-metal tools of similar construction to the permanent version
Medieval breakthrough
One of the key players who made the real breakthrough in surgical instrumentation was Abu al-Qasim al-Zahrawi, known in the West as Abulcasis, and considered the "father of modern surgery". The first observation one must make at the outset is that Al-Zahrawi wrote his famous Al-Tasrif liman 'Ajiza 'an Al Ta'leef (written in 1000 CE), translated as The Method of Medicine, and often referred to as Al-Tasrif, after long experience accumulated over fifty years of practising medicine. The book, therefore, was aimed to establish the general guidelines in the practical medicine by emphasising the "do" and "don’t" in almost every issue encountered and the solutions/ treatments he provided or invented during this long experience.
History
Surgical instruments have been manufactured since prehistoric times. Rough trephines for performing round craniotomies have been discovered in many neolithic sites. It is believed that they were used by shamans to release evil spirits and alleviate headaches and head traumas caused by war-inflicted wounds.
Surgeons and physicians in India have used sophisticated surgical instruments since ancient times. Sushruta Samhita (circa 500 BC) was probably the most important surgeon in ancient history, often known as the "father of surgery". In his text Sushruta Samhita he described over 120 surgical instruments, 300 surgical procedures and classified human surgery in 8 categories.
In Antiquity, surgeons and physicians in Greece and Rome developed many ingenious instruments manufactured from bronze, iron and silver, such as scalpels, lancets, curettes, tweezers, specula, trephines, forceps, probes, dilators, tubes, surgical knives, etc. They are still very well preserved in several medical museums around the world. Most of these instruments continued to be used in Medieval times, albeit with a better manufacturing technique.
Surgeons and physicians in India have used sophisticated surgical instruments since ancient times. Sushruta Samhita (circa 500 BC) was probably the most important surgeon in ancient history, often known as the "father of surgery". In his text Sushruta Samhita he described over 120 surgical instruments, 300 surgical procedures and classified human surgery in 8 categories.
In Antiquity, surgeons and physicians in Greece and Rome developed many ingenious instruments manufactured from bronze, iron and silver, such as scalpels, lancets, curettes, tweezers, specula, trephines, forceps, probes, dilators, tubes, surgical knives, etc. They are still very well preserved in several medical museums around the world. Most of these instruments continued to be used in Medieval times, albeit with a better manufacturing technique.
Surgical instrument
A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps), or a compound scientific name related to the kind of surgery (for example, a tracheotome is a tool used to perform a tracheotomy).
The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a surgical technologist or sometimes a nurse or radiologic technologist.
The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a surgical technologist or sometimes a nurse or radiologic technologist.
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