The fourth wave of surgery and organ transplantation

Surgery entered a new era with the first surgery under general anesthesia on October 16, 1846 at Harvard University in Boston, USA. Prior to that, surgeries were limited and many surgeons were not physicians. This is called the first wave of surgery.
After October 16, 1846, surgery entered its second wave. In this era, surgeries spread rapidly and new branches such as heart surgery, neurology, gynecology, etc. were created. But mortality from surgery or subsequent infections had made occupational therapy a high-risk discipline. Only a minority of patients recovered during this period. With scientific advances in anesthesia, postoperative care, the principles of clean and sterile surgery, and the discovery of antibiotics, mortality from surgery gradually declined, and the science entered a third wave. However, the complications of surgery were still high, which led to a decrease in the quality of life of patients.
Gradually, from the mid-1970s, the scientific attitude in this science changed radically and the fourth wave of surgery began. It was no longer just a matter of reducing mortality. During this time, deaths from major surgeries such as heart, brain and viscera had dropped to less than 5 percent. But the prevalence of complications remained high, with postoperative complications leading to prolonged hospitalization, high costs, disability, and reduced patient health. The goal of the fourth wave of surgery was to bring the individual back into the arms of the family and the community, so that the patient would have a good quality of life.
Perhaps an example that can well illustrate this transformation in surgery is breast cancer surgery. Before the period of general anesthesia (ether age), surgery for breast cancer was rarely performed. And the majority of patients with the disease died. In the second wave of surgery, breast cancer entered a new phase by removing the breast and chest wall muscles. William Hasthead at Johns Hopkins University in Maryland, USA, showed that some patients could be saved by having this surgery, but the death toll from the surgery was still high.
Advances in anesthesia and postoperative care have reduced patient mortality. However, this surgery was associated with changes in the unpleasant dimensional appearance of the patients due to removal of the chest muscles. This surgery, which saved patients from cancer, changed the appearance of the body in a way that caused many psychological problems for the patient and greatly affected his quality of life. Many women even protested against this type of surgery. Gradually, breast cancer surgeries got smaller and smaller. First, the removal of the chest muscles became obsolete. It was then shown that only part of the breast could be removed instead of removed. Removal of axillary lymph nodes was still a major component of this surgery. This sometimes led to swelling of the arms and hands, which was very problematic for the patient and disrupted his daily activities. It was gradually shown that instead of removing all the axillary lymph nodes, only one or two glands could be removed, but this would provide sufficient information for physicians to treat the patient. Today, breast cancer surgery has become a limited surgery that can be performed in surgical clinics, so that the patient is discharged a few hours after surgery.
Another example is the introduction of minimally invasive surgeries, such as laparoscopic or endoscopic surgeries. In these surgeries, a small incision can be made into the body cavities. For example, in abdominal surgery, it is called laparoscopy (seeing inside the abdomen) and this way the patient can be treated. This type of surgery is associated with less damage to the patient’s body. Therefore, the patient’s pain and recovery period is reduced and the person returns to normal life sooner. In the endoscopic method, it is possible to enter different parts of the body through a special camera through the nose, mouth, or anus and perform occupational therapy.
Another example is organ transplantation. Due to the prevalence of chronic diseases such as hypertension or diabetes, many patients today have organ failure and are at risk of death. Organ transplantation is the best way to treat this problem, which has revolutionized medical science by increasing the life expectancy of these patients and improving their quality of life.
These surgeries have been so successful in recent decades that they have reduced patient mortality and returned them to family and community. The quality of life of these people is far better than that of people with organ failure. In addition, the cost of organ transplants is much lower than the cost of treating organ failure.
With the arrival of the fourth wave, surgeries have been associated with fewer deaths and complications, resulting in a better quality of life for patients. With scientific and technological advances such as stem cells, genetic engineering, nanoscience, and 3D printers, the question is whether surgery will end in the future. This is a question that can only be answered in the future.

Dr. Reza Saidi Firoozabadi – Transplant Surgeon