Surgery Archives - Dr Christian Jeske https://generalsurgery.co.za/category/surgery/ Your liver, pancreas & gastrointestinal specialist surgeon Tue, 22 Sep 2026 08:17:57 +0000 en-ZA hourly 1 https://wordpress.org/?v=7.1.3 https://generalsurgery.co.za/wp-content/uploads/2021/07/DrJeske-Favicon.png Surgery Archives - Dr Christian Jeske https://generalsurgery.co.za/category/surgery/ 32 32 History of Surgery https://generalsurgery.co.za/history-of-surgery/ Mon, 21 Sep 2026 08:23:33 +0000 https://generalsurgery.co.za/?p=1977 A timeline of major global and South African milestones in the history of surgery, presented by Dr Christian Jeske.

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MAJOR DEVELOPMENTS IN THE HISTORY OF SURGERY

People | discoveries | innovations | better lives

As a surgeon in daily practice, I am often reminded of the responsibility we carry. Patients, their families and friends place their hopes, expectations and, at times, their lives in our hands.

Yet much of what we rely on every day is easily taken for granted. Modern surgery rests on the work of generations of scientists, physicians, surgeons, nurses, engineers, researchers and countless support personnel. Every safe anaesthetic, sterile instrument, blood transfusion, scan, antibiotic and surgical technique has a history behind it.

It is worthwhile, occasionally, to look back at that history — not only to appreciate how far surgery has come, but also to recognise the extraordinary collective effort that has made what we do today possible.

PEOPLE | IDEAS | INNOVATIONS | BETTER LIVES

Major Developments in the History of Surgery timeline showing global milestones and South African contributions
Full timeline overview. On smaller screens, swipe horizontally to view the detail; click the image to enlarge it in a lightbox.
Global Milestones
South African Contributions

Global Milestones (15 selected developments)

From ancient practices to robotic surgery — the innovations that shaped modern medicine.

Ancient world–Middle Ages

Early surgical practice

Imhotep; Sushruta; Hippocratic/Greco-Roman practitioners; Al-Zahrawi

Wound care, fracture treatment, suturing, cautery and purpose-made instruments were described and refined across several medical traditions.

Created systematic approaches to wounds, fractures and reconstruction; many instrument concepts remain recognisable.

Ancient surgical instruments
Ancient surgical instruments and medical practice (representative)
1543 / Renaissance

Scientific human anatomy

Andreas Vesalius and Renaissance anatomists

Direct study of human bodies corrected many inherited anatomical errors and produced more reliable descriptions of organs and structures.

Gave surgeons a much more accurate map of the human body and improved operative planning.

Vesalian anatomical study
Vesalian anatomical study, 16th century (representative)
16th century

Better control of bleeding

Ambroise Paré

Paré promoted tying bleeding vessels after amputation instead of routinely burning them, and advocated gentler wound care.

Reduced suffering and helped move surgery toward observation and practical evidence.

Ambroise Paré and early vessel ligation
Ambroise Paré and early vessel ligation (representative)
1840s

Surgical anaesthesia

Crawford Long; Horace Wells; William T. G. Morton; James Young Simpson

Ether, nitrous oxide and chloroform made it possible to prevent severe pain during operations. Morton's 1846 public ether demonstration accelerated adoption.

Allowed surgeons to work more slowly and deliberately and made major internal operations feasible.

Public ether anaesthesia demonstration, 1846
Public ether anaesthesia demonstration, 1846 (representative)
1847–1900

Hand hygiene, antisepsis and sterile surgery

Ignaz Semmelweis; Louis Pasteur; Joseph Lister; Ernst von Bergmann; operating-room teams

Hand cleaning, germ theory, antiseptic wound treatment, heat sterilisation and increasingly sterile operating practice developed in stages.

Postoperative infection fell dramatically, allowing safer surgery inside the chest, abdomen and other body cavities.

Antiseptic and sterile operating practice
Antiseptic and sterile operating practice (representative)
1860s onward

Modern nursing and organised perioperative care

Florence Nightingale; professional nurses; hospital reformers

Trained nursing, sanitation, observation and record-keeping became integral to hospital care.

Reduced preventable complications and created the coordinated care needed before and after major surgery.

Florence Nightingale and modern nursing reform
Florence Nightingale and modern nursing reform (representative)
1895 onward

Medical imaging

Wilhelm Conrad Röntgen; radiologists; physicists; engineers

X-rays allowed doctors to see bones and foreign bodies without an operation. Ultrasound, CT, MRI and intraoperative imaging followed.

Improved diagnosis, planning and navigation while reducing unnecessary exploratory surgery.

Early X-ray imaging of the hand
Early X-ray imaging of the hand (representative)
1901–1940s

Blood typing, transfusion and blood banking

Karl Landsteiner; Richard Lewisohn; Oswald Robertson; Charles Drew; transfusion teams

Blood groups were identified and methods for anticoagulation, storage and organised blood banking were developed.

Made replacement of major blood loss reliable enough for trauma and increasingly complex operations.

Blood typing, storage and transfusion practice
Blood typing, storage and transfusion practice (representative)
1930s–1940s

Antibiotics

Gerhard Domagk; Alexander Fleming; Howard Florey; Ernst Chain; clinical teams

Sulfonamides and then penicillin transformed treatment of bacterial wound and postoperative infections.

Reduced infection-related deaths and widened the range of operations that patients could survive.

Alexander Fleming and the development of penicillin
Alexander Fleming and the development of penicillin (representative)
Early–mid 20th century

Vascular surgery

Alexis Carrel; René Leriche; Michael DeBakey and others

Surgeons developed dependable methods to join, replace and bypass blood vessels.

Enabled limb salvage, aneurysm repair, organ transplantation and much of modern heart surgery.

Vascular surgery pioneer in an operating theatre
Vascular surgery (representative)
1950s

Open-heart surgery

John Gibbon; C. Walton Lillehei; cardiac teams; perfusionists; engineers

The heart–lung machine could temporarily take over circulation and oxygenation while surgeons worked inside the heart.

Made repair of complex heart defects and later valve and coronary operations possible.

Heart-lung machine and open-heart surgery
Heart–lung machine and open-heart surgery (representative)
1954 onward

Organ transplantation

Joseph Murray; Peter Medawar; Thomas Starzl; Roy Calne; transplant teams

Kidney transplantation was followed by liver, heart and other organ transplantation as immune-suppressing treatment and organ preservation improved.

Changed some forms of end-stage organ failure from inevitably fatal disease into treatable conditions.

Kidney transplantation operating theatre in 1954
Kidney transplantation at Boston in 1954.
1960s–1980s

Microsurgery and reconstruction

Julius Jacobson; Harry Buncke; Chen Zhongwei; reconstructive teams

Operating microscopes and very fine sutures allowed surgeons to reconnect tiny blood vessels and nerves.

Enabled replantation of severed parts, free-tissue transfer and more sophisticated reconstruction after trauma and cancer.

Microsurgery using an operating microscope
Microsurgery using an operating microscope (representative)
1980s–2000s

Minimally invasive and endoscopic surgery

Kurt Semm; Erich Mühe; Philippe Mouret; multidisciplinary teams

Cameras and long instruments allowed many operations to be performed through small openings rather than large incisions.

Often reduced pain and hospital stay and sped recovery, while creating new training and safety requirements.

Laparoscopic instruments used through small incisions
Laparoscopic instruments used through small incisions (representative)
2000s–present

Robotic, image-guided and data-assisted surgery

Surgical teams; radiologists; engineers; computer scientists

Robotic systems, 3-D imaging, navigation, simulation and AI-based tools are increasingly integrated into selected procedures.

Can improve visualisation, access and precision in selected settings; evidence, cost, access and accountability remain important.

Robotic and image-guided operating theatre
Robotic and image-guided operating theatre (representative)

Contact

(012) 644 1327, or use any of the provided links on our website or facebook page to book or send us an e-mail at unitas@generalsurgery.co.za.

We are dedicated to helping you. Please note that this information is not exclusive

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]]> Disease of endocrine pancreas https://generalsurgery.co.za/disease-of-endocrine-pancreas/ Mon, 27 Feb 2023 09:48:16 +0000 https://generalsurgery.co.za/?p=1712 Pancreatic cancer is known as the eighth most common cancer in the world, Dr Christian examines the pancreas and options for patients.

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Disease of endocrine pancreas

About the pancreas

The pancreas lies behind your stomach, extending laterally from the duodenum toward the spleen. The pancreas is an elongated, pinkish grey organ with a length of about 15cm and weight of about 80g. The broad head of the pancreas lies within the loop formed by the duodenum. The slender body of the pancreas extends toward the spleen, and the tail is short and bluntly rounded. The surface of the pancreas has a lobular texture.

Arterial blood supply includes the branches of the splenic, superior mesenteric and common hepatic arteries. The pancreatic arteries and pancreaticoduodenal arteries are the major branches from these vessels. The splenic vein and its branches drain the pancreas.

The pancreas is primarily an exocrine organ, producing digestive enzymes and buffers. The large pancreatic ducti (Duct of Wirsung) deliver theses secretions to the duodenum. A small accessory pancreatic duct or duct of Santorini may branch from the pancreatic duct. This pancreatic duct extends within the attached mesentery to reach the duodenum, where it meets the common bile duct from the liver and gallbladder. These two ducts empty into the duodenal ampulla, a chamber located roughly halfway along the length of the duodenum.

Functions of the pancreas

The pancreas has digestive and hormonal functions and is known as the only organ in the body to have both endocrine and exocrine secretions. Each day your pancreas secretes abut 1000ml of pancreatic juice. The secretory activities are controlled primarily by hormones from the duodenum. Furthermore, some enzymes are secreted as inactive proenzymes that are activated only after they reach the small intestine. The release of proenzymes rather than active enzymes in the pancreas protects the secretory cells from the destructive effects of their own products.

Carcinoma of the pancreas (Cancer)

Pancreatic carcinoma has become the third leading cause of death in the United States and is known to be the eight most common cancer in women and tenth in men respectively. Pancreatic cancer usually occurs after the age of 50 years and increases in incidence with age, with most patients diagnosed between the ages of 60 and 80 years of age.

Carcinomas occur more often in the head of the pancreas (70%) and body (20%) than in the tail which accounts for 10% of the cases. Carcinoma of the head of the pancreas tend to obstruct the common bile duct early in their course, with resulting jaundice, and can extend into the uncinate processes to involve the superior mesenteric artery and vein, thus compromising surgical respectability. Tumours of the body and tail tend to present later in their course, as they cause few symptoms until they become quite large. Patients with carcinoma of the body or tail of the pancreas typically present with epigastric abdominal pain, profound weight loss, abdominal mass, and early satiety. Due to the vague nature of the symptoms, patients tend to present at later stages, often with distant metastases, particularly in the liver. Microscopically, 90% of pancreatic cancers are adenocarcinomas; the remainder are adenosquamous, anaplastic, or acinar cell carcinomas.

Risk factors of pancreatic cancer includes

  • Cigarette smoking has the strongest overall association and is thought to account for one-quarter of cases diagnosed.
  • High dietary intake of saturated fat (cream, butter, cheese, pastries, cured meats, chocolate etc.)
  • The role of other dietary factors such as coffee, high fat intake and the use of alcohol are still much debated.
  • Diabetes mellitus has also recently been identified as a risk factor for the disease.
  • Chronic pancreatitis increases the risk of developing pancreatic adenocarcinoma by 10 – 20-fold.

Whipple Procedure (Pancreaticoduodenectomy)

A Whipple procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the common bile duct, with reestablishment of continuity of the biliary, pancreatic, and GI tract systems. Gastrointestinal continuity is re-established by connecting a portion of the intestine to the bile duct, remaining pancreatic body/tail, and the stomach or duodenum. The procedure may take anything from 6-12 hours, with post operative High care for 7-10 days if no complications arise.

References

  • Martini, F. and Ober, W.C. (2001). Fundamentals of anatomy & physiology: [main volume]. Upper Saddle River, N.J.: Prentice Hall.
  • Mcphee, S.J. and Hammer, G.D. (2019). Pathophysiology of disease: an introduction to clinical medicine. 8th ed. New York: Mcgraw-Hill Education Medical.
  • Lowe, J.S., Anderson, P.G., Anderson, S.I. and Stevens, A. (2020). Stevens & Lowe’s human histology. Amsterdam: Elsevier.
  • www.bartleby.com. (n.d.). Illustrations. Fig. 1062. Gray, Henry. 1918. Anatomy of the Human Body. [Online – Accessed 11 Aug. 2022].
  • Edythe Louise Alexander, Rothrock, J.C. and Mcewen, D.R. (2015). Alexander’s care of the patient in surgery. St. Louis, Missouri: Elsevier/Mosby.

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]]> Laparoscopic Surgery https://generalsurgery.co.za/laparoscopic-surgery/ Mon, 16 Jan 2023 06:12:33 +0000 https://generalsurgery.co.za/?p=1692 Laparoscopic surgery is a minimally invasive surgical technique. Dr Jeske discusses the advantages and myths surrounding laparoscopic surgery.

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Laparoscopic surgery

Laparoscopic surgery is a minimally invasive surgical technique used in the abdominal and pelvic areas. It uses the aid of a laparoscope — a thin, telescopic rod with a camera at the end — to see inside your body without opening it all the way up. Instead of the 15-30cm cut necessary for open abdominal surgery, laparoscopic surgery uses two to four small incisions of half a centimetre or less. One is for the camera, and the others are for the surgical instruments. Minimally invasive surgery may also be called “keyhole surgery,” referring to these small incisions.

History and Pioneers of Laparoscopic procedures

  • Endoscopy is derived from Greek and means “viewing the inner spaces of the human body” (“endo” and “skopein”)
  • Georg Kelling was the first to describe the basic principles of endoscopy of the abdomen. Kelling performed the procedure in a dog. Almost exactly a hundred years ago, Jacobaeus performed the first endoscopy in humans. Major advancements in endoscopy were accomplished from the 1960s to the 1980s, accompanied by a transition from diagnostic to surgical laparoscopy. These developments are inseparably linked with the names of Raoul Palmer in Paris and Kurt Semm in Kiel.
  • The first laparoscopic appendectomy was performed by Semm on 13 September 1980 at the department of obstetrics and gynaecology, University of Kiel. 

Advantages of laparoscopic surgery

  • Smaller incisions and smaller scars
  • Less pain than open procedures
  • The chances of infection after the procedure are lower than with open procedures
  • Faster recovery for the patient
  • Shorter hospital stays
  • Due to the increase in intra-abdominal pressure, patients bleed less than with open procedures.

Disadvantages of laparoscopic surgery

  • Sometimes the procedure must be converted to an open procedure due to bleeding or other complications
  • Limited degree of motion
  • Increased operation time
  • Increased technical difficulty

Procedures done laparoscopically by Dr Jeske

  • Laparoscopic incisional hernia repair – This is a bulge or area of weakness in the muscles which form the lower front of the stomach in the groin region.
  • Laparoscopic drainage of abscess in the liver, pancreas, and abdomen
  • Laparoscopic liver resections and liver biopsies – The reason for removing part of the liver is likely due to one or more growths, cancerous or non-cancerous. Trauma to the liver is also a possible indication for this operation. A liver biopsy may be done to look for the cause of liver abnormalities, to assess if, and how much, the liver is damaged and/or to help in planning treatment.
  • Laparoscopic cholecystectomy – Removal of the gallbladder due to gallstones, both the gallbladder and stones are removed.
  • Laparoscopic appendicectomy – Removal of the appendix due to infection which causes pain and can ultimately rupture.
  • Laparoscopy for diagnostic purposes
  • Laparoscopic hemicolectomies – Removal of part of the large intestine due to cancer or other obstructions.
  • Laparoscopic splenectomy – Removal of the spleen may be due to Splenic cysts, abscesses, or tumours. Spleen damaged because of certain auto-immune diseases or traumatic trauma may also be an indication to remove the spleen.

Myths and facts about laparoscopic surgeries

  1.  Myth – Laparoscopic surgery is more costly than open surgery
    Fact – Since patients have a shorter hospital stay and can return to work quicker the costs of laparoscopic procedures are less than that of open surgeries.
  2. Myth – Visualization of the abdomen is limited using lapscopes
    Fact – Laparoscopy provides better visualization of the abdomen when compared to the open approach.
  3. Myth – Patients with multiple previous abdominal surgeries cannot have a laparoscopic procedure.
    Fact – Laparoscopy can be safely performed in patients with multiple prior surgeries regardless of the size or location of the prior skin incisions.

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