Preface

This publication aims to support young doctors and surgery residents during their training period. A surgical residency is a crucial period for a young doctor. A great volume of theoretical information along with difficult and demanding practical skills need to be acquired in a relatively short period of time. Often, we are tempted to focus on specific pathologies, complex surgical interventions, or innovative minimally invasive procedures and we skip the basic principles of a surgical act, which should be the pillar of further development. Consolidating basic notions and skills in surgery not only can help us learn and master different surgical steps and further complete interventions, but applied on time and correctly could represent a saving gesture.

In the field of surgery, significant progress has been made in the last few decades in both molecular and surgical pathology. Current research activity focuses more and more on identifying and characterizing molecules that play a role in cancer carcinogenesis, but also in finding new and effective therapeutic targets. Not least, many biomarkers have been studied in various types of cancer as predictors of advanced stages of neoplastic disease or poor overall survival, but results are not homogeneous.

This book is a tool for rapid, suitable acquisition of elementary surgical notions and techniques, which represent the basis for training today's resident to become tomorrow's surgeon.

> **Miana Gabriela Pop** 'Iuliu Hațieganu' University of Medicine and Pharmacy, Cluj-Napoca, Romania

**1**

Section 1

Introduction

Section 1 Introduction

**3**

represent the main disadvantage [9].

**Chapter 1**

*Miana Gabriela Pop*

**1. Introduction**

Introductory Chapter: General

The history of surgery begins in antiquity, when various maneuvers were performed in order to treat injury and wounds. The results of these procedures were mostly characterized by increased rates of massive bleeding and severe infectious complications. An important role in surgery progress at that time has been the development of varied instruments which have begun to be used more and more in surgical practice. Initially characterized by elevated rates of postoperative mortality, surgery developed furthermore after the introduction, at the end of the nine-

Claudius Galen (129–200 AD) introduces for the first time the use of catgut for surgical sutures. Galen also made important contributions in the field of anatomy; he was the first to describe the anatomy of the recurrent laryngeal nerve [1]. Moreover, he demonstrated their importance in phonetics by cutting, in front of an auditory in Rome, the recurrent laryngeal nerves of a pig that remained afterward mute [1].

The first successful open appendectomy of an 11-year-old boy was reported, back in 1735, by Claudius Aymand (1681–1740), while the first laparoscopic removal of the appendix was realized in 1981 by Kurt Semm [2]. For years after, the gallbladder was removed for the first time through laparoscopy [3]. Before the introduction of laparoscopic techniques as a treatment option in various human pathologies, a large number of experimental interventions were performed on animals. Georg Kelling was the promoter of this learning technique, most of his experimental studies being performed on dogs [4]. The first laparoscopic intervention was performed on a human in 1910 by Hans Christian Jacobaeus and consisted of a "laparothoracoscopy" [5].

Due to the enthusiasm in terms of implementation of minimally invasive surgical techniques, natural orifice transluminal endoscopic surgery (NOTES) has been further developed. In 2004, the team lead by Dr. Kallo at the Johns Hopkins University reported

After the revolution of laparoscopic procedures, robotic-assisted surgery was introduced in 1983, along with increasing interest in virtual reality [8]. Currently, there are several types of robotic systems (AESOP, EndoAssist, Neuromate, da Vinci, PROBOT (surgeon robot for prostatectomies), PAKY (robotic system for percutaneous access)), each with its advantages and disadvantages [8]. Some of the main advantages of robotic surgery are better three-dimensional (3D) vision and better ergonomics; the removal of psychological tremor while increase costs would

the first NOTES procedure and demonstrated the feasibility of intra-abdominal exploration through the use of an endoscope [6]. Since then, the hybrid techniques have been developed as a combined endoscopic and laparoscopic approach [7].

Surgery in the Era of Modern

Molecular Biomarkers

teenth century, of aseptic and antiseptic methods.
