Surgery
Overview
Surgery (수술, surgery) is a medical procedure that applies physical manipulations such as incising, excising, suturing, or transplanting a patient's body tissues to treat or diagnose disease, injury, deformity, or functional impairment. Its scope ranges widely from simple procedures to organ transplantation, and with the development of anesthesia, aseptic technique, blood transfusion, and antibiotics, it advanced rapidly after the 19th century and became a central pillar of modern medicine. Recently, it is evolving rapidly into technology-convergent care such as robotic surgery, minimally invasive surgery, and remote surgery.
Main Content
Definition and Etymology
The Korean word 'surgery' (수술) is a Sino-Korean term meaning 'to govern by hand,' and the Western word surgery derives from the Greek kheirourgia (handwork). In the past, it was distinguished from internal medicine (內科) under the name surgery (外科), but in modern times it has been subdivided into detailed specialties by organ and disease, and multidisciplinary care in close cooperation with medical treatment has become common.
Historical Development
Records indicate that trepanation and cataract surgery were already performed in ancient Egypt and India. Medieval Islamic physicians systematized surgical instruments and techniques, and during the Renaissance, advances in anatomy deepened understanding of the human body. The introduction of ether anesthesia in 1846, Lister's establishment of aseptic and antiseptic methods in 1867, and the spread of antibiotics and blood transfusion techniques in the 20th century are called the 'three major revolutions of surgery' and dramatically lowered surgical mortality.
Classification
Surgery is divided by several criteria. By purpose, it is classified into therapeutic surgery for treatment, diagnostic surgery such as biopsy for diagnosis, and elective surgery for cosmetic or functional improvement. By urgency, it is divided into emergency surgery requiring immediate performance, semi-emergency surgery performed within a few days, and planned scheduled surgery. By degree of invasiveness, it is divided into open abdominal and thoracic surgery with large incisions and minimally invasive surgery using endoscopy or laparoscopy, and by transplantation status, it is also classified into autograft, allograft, and xenograft.
Preoperative Evaluation and Preparation
Before surgery, the patient's general condition and anesthetic risk are assessed through history taking, physical examination, blood tests, electrocardiography, and imaging. The American Society of Anesthesiologists (ASA) physical status classification is widely used to predict surgical risk. Compliance with fasting guidelines, management of anticoagulants and blood glucose, administration of prophylactic antibiotics to prevent infection, and obtaining informed consent are essential, and recently preoperative rehabilitation (prehabilitation) and nutritional management have been emphasized as improving recovery outcomes.
Anesthesia
Anesthesia is divided into general anesthesia, spinal and epidural anesthesia, regional anesthesia, and local anesthesia. General anesthesia involves airway management, artificial ventilation, and cardiovascular monitoring, and the patient's vital signs are continuously monitored during anesthesia. Anesthesiologists and nurse anesthetists cooperate, and multimodal analgesia for postoperative pain management has become standard.
Surgical Procedure and Aseptic Principles
In the operating room, strict aseptic principles are applied, including hand hygiene, wearing sterile gowns and gloves, maintaining the sterile field, and counting instruments. Surgery proceeds through the stages of incision, exposure, management of the lesion, hemostasis, and closure, and blood loss, body temperature, and fluid balance are managed in real time. The WHO Surgical Safety Checklist contributes to reducing preventable accidents by checking patient identity, site marking, and instrument counts before surgery, before induction of anesthesia, and after surgery.
Postoperative Care and Complications
After surgery, pain control, early ambulation, prevention of respiratory complications, wound care, and thrombosis prevention are key. Representative complications include bleeding, infection (surgical site infection), anesthesia-related complications, pneumonia and atelectasis, deep vein thrombosis, intestinal adhesions, and anastomotic leakage, and the risk varies depending on the patient's underlying diseases and the extent of surgery. The Enhanced Recovery After Surgery (ERAS) protocol has spread as a standard that reduces complications and length of stay through shortened fasting periods, minimally invasive approaches, multimodal analgesia, early feeding, and early discharge.
Major Surgical Fields
Representative fields include general surgery (abdomen, digestive tract, thyroid), orthopedics (joints, spine, fractures), neurosurgery (brain, spinal cord), thoracic surgery (heart, lungs), plastic surgery (reconstruction, cosmetic), obstetrics and gynecology, urology, otolaryngology, and ophthalmology, and subspecialties such as pediatric surgery and transplant surgery also exist. Organ transplantation, tumor resection, coronary artery bypass grafting, and artificial joint replacement are considered representative achievements of modern medicine.
Recent Trends
As of 2024–2025, the biggest change in the surgical field is the combination of minimally invasive and digital technologies. Robot-assisted surgery (such as the da Vinci series) is increasing precision in urological, prostate, and gastrointestinal surgery, and single-port robots and flexible robotic endoscopes have entered the commercialization stage. Artificial intelligence is being used for preoperative image analysis and 3D reconstruction, intraoperative recognition of anatomical structures, and prediction of postoperative complications. Surgical navigation based on augmented reality (AR) and mixed reality (MR) is being applied to liver, brain, and spine surgery, and research on remote surgery and telesurgery is also progressing while solving network latency issues. In addition, patient-specific 3D-printed implants, bioprinted tissues, regenerative medicine surgery combined with cell therapy, and therapeutic approaches using gene editing are in the clinical research stage. AI-based surgical record automation and operating room operation optimization are also being rapidly introduced. On the other hand, surgical workforce shortages, demands to improve residents' working conditions, surgical risk management due to the increase in elderly patients, and debates over the cost-effectiveness of robotic surgery are emerging as major social issues.
Related Topics
- [[Anesthesia]]
- [[Surgery]]
- [[Robotic surgery]]
- [[Organ transplantation]]
- [[Aseptic technique]]
- [[Medicine]]
- [[Minimally invasive surgery]]
- [[Postoperative recovery]]