During the First and Second Industrial Revolutions in the 18th and 19th centuries, Western countries made significant progress in understanding the anatomical structure of human organs, addressing challenges related to anesthesia, hemostasis, transfusion, postoperative infection, and fundamental surgical techniques. These advancements laid the foundation for modern surgery.
Anatomy
In 1859, Gray published Gray's Anatomy: Descriptive and Surgical, which has been widely used as a medical textbook and remains influential to this day.
Anesthesia
In 1800, Davy discovered the anesthetic effects of nitrous oxide (laughing gas). In 1842, American physician Long used ether for general anesthesia during the removal of a skin tumor. In 1847, Simpson in Edinburgh successfully utilized chloroform as an anesthetic. In 1887, Schleich in Germany began using cocaine for local infiltration anesthesia, but due to its high toxicity, it was soon replaced by procaine. Procaine remains a safe and effective local anesthetic to this day.
Blood Transfusion
Massive bleeding is one of the major causes of mortality from trauma and surgery, and blood transfusion can save lives. Following Landsteiner's 1901 discovery of blood types, the safety of blood transfusion significantly improved.
Postoperative Infection
A century ago, surgical infection was a significant challenge. Hungarian obstetrician Semmelweis (1818–1865) demonstrated that postpartum fever was an infectious disease and introduced the practice of washing hands with chlorinated lime solution before deliveries. This intervention reduced the maternal mortality rate from 10% to 1%, marking the beginning of antisepsis. British surgeon Lister (1827–1912) introduced the use of phenol as an antiseptic to sterilize instruments and the operating room, reducing the mortality rate in amputation patients from 45% to 15%.
German bacteriologist Koch identified the pathogens responsible for wound infections in 1878. Bergmann (1836–1907) established the steam sterilization method for disinfecting surgical dressings, advancing the transition from antisepsis to asepsis. In 1887, Mikulicz-Radecki advocated for the use of surgical masks, and in 1889, Fürbringer proposed methods for disinfecting surgeons' arms, while Halsted in 1890 promoted the use of sterilized rubber gloves. These developments perfected aseptic techniques. The discovery of penicillin by Fleming in 1928 and the introduction of sulfonamides by Domagk in 1935 further elevated the prevention and treatment of postoperative infections to a new level.
Fundamental Surgical Techniques
By the 1880s, operations on the head, chest, and abdomen were still considered prohibitive zones. Two key technical challenges needed to be addressed:
Hemostasis and Control of Intraoperative Bleeding
In 1872, Wells in Britain formally used hemostatic clamps during surgery, while Esmarch in Germany introduced tourniquets in 1873 to control bleeding during amputations. Pringle, in 1908, demonstrated the use of thumb and index fingers to compress the hepatoduodenal ligament to control bleeding in liver surgeries. Techniques for intraoperative hemostasis were gradually refined.
Reconnecting Hollow Organs
Reattaching the severed ends of hollow organs, including structures in the gastrointestinal tract and blood vessels, presented another major challenge. Wolfler (1881) and Billroth (1829–1894) advanced gastrointestinal anastomosis techniques. Lembert proposed the basic principle of intestinal sutures, involving the serosa-to-serosa anastomosis method. Carrel (1902) developed the concept of using three holding sutures to reshape the circular ends of blood vessels into a triangular form to facilitate suturing. For this achievement, he received the Nobel Prize in Physiology or Medicine in 1912.
For today’s medical students, performing surgery to treat certain conditions seems routine. However, before the early 20th century, the overall level of surgery was still quite rudimentary. Surgery only entered a period of rapid development during the mid-20th century, following the onset of the Third Industrial Revolution, when significant breakthroughs in scientific theories were achieved. During this period, advancements in basic medicine, computer technology, information technology, and bioengineering propelled surgery into a new era of progress.
In the early 1950s, the development of hypothermic anesthesia and cardiopulmonary bypass made open-heart surgery possible. Microsurgical techniques advanced trauma surgery, reconstructive surgery, and limb replantation. Subsequently, imaging technologies such as ultrasound, CT, and MRI were successfully introduced to clinical practice, significantly enhancing the diagnostic accuracy for surgical diseases and enabling more rational surgical planning. Innovations such as electrosurgical tools, ultrasonic scalpels, ultrasonic aspirators (CUSA), and staplers reduced surgical difficulty, minimized intraoperative bleeding, decreased postoperative complications, and improved the overall safety of surgeries.
Endoscopy, laparoscopy, catheter-based interventions, and hybrid operations fueled the development of minimally invasive surgery. The creation of new-generation anti-rejection drugs and organ preservation solutions made clinical organ transplantation a safe, effective, and feasible routine surgical procedure.
In 2013, Germany introduced the concept of "Industry 3.0," kickstarting the Fourth Industrial Revolution and ushering in an era of intelligent technology. A series of cutting-edge technologies have increasingly integrated with medicine, driving continuous progress in modern medical science. Innovations such as artificial intelligence (AI), mixed reality (MR), surgical robotics, telemedicine, three-dimensional (3D) printing, brain-computer interfaces (BCI), computer-assisted surgical navigation systems, and blockchain have been applied to surgical practice and education. These technologies have provided new solutions and ideas for addressing challenges in modern surgery, fostering its ongoing development and advancement.