Surgery 45599 226136162 2008-07-16T23:52:49Z Kusb 5271788 /* Terminology */ {{otheruses1|the medical specialty}} [[Image:Surgeon operating, Fitzsimons Army Medical Center, circa 1990.JPEG|thumb|right|A cardiothoracic surgeon performs a [[mitral valve replacement]] at the [[Fitzsimons Army Medical Center]].]] '''Surgery''' (from the {{lang-el|χειρουργική}} ''cheirourgikē'', via {{lang-la|chirurgiae}}, meaning "hand work") is a medical specialty that uses operative manual and instrumental techniques on a [[patient]] to investigate and/or treat a pathological condition such as [[disease]] or [[injury]], to help improve bodily function or appearance, or sometimes for some other reason. An act of performing surgery may be called a '''surgical procedure''', '''operation''', or simply '''surgery'''. In this context, the verb '''operating''' means performing surgery. The adjective '''surgical''' means pertaining to surgery; e.g. [[surgical instruments]] or [[surgical nurse]]. The patient or subject on which the surgery is performed can be a person or an animal. A [[surgeon]] is a person who performs operations on patients. Persons described as surgeons are commonly [[medical practitioner]]s, but the term is also applied to [[podiatry|podiatrists]], [[dentist]]s and [[veterinarian]]s. Surgery can last from minutes to hours, but is typically not an ongoing or periodic type of treatment. The term ''surgery'' can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian. ==Definitions of surgery== Surgery is a medical technology consisting of a physical intervention on tissues. As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as [[angioplasty]] or [[endoscopy]], may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment, [[anesthesia]], [[antiseptic]] conditions, typical [[surgical instruments]], and [[suturing]] or [[Surgical staple|stapling]]. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being excised (i.e. laser ablation of the cornea) or to a radiosurgical procedure (i.e. irradiation of a tumor). ===Types of surgery=== Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation. [[Elective surgery]] is done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. [[Emergency medicine|Emergency surgery]] is surgery which must be done quickly to save life, limb, or functional capacity. [[Exploratory surgery]] is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition. [[Amputation]] involves cutting off a body part, usually a limb or digit. [[Replantation]] involves reattaching a severed body part. [[Reconstructive surgery]], also commonly called plastic surgery, involves reconstruction of an injured, mutilated, or deformed part of the body. A subset of reconstructive surgery is [[cosmetic surgery]], which is done to improve the appearance of an otherwise normal structure. [[Excision]] is the cutting out of an organ, tissue, or other body part from the patient. [[Organ transplant|Transplant]] surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery. When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones and/or muscles). [[Minimally invasive surgery]] involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in [[laparoscopic surgery]] or [[angioplasty]]. By contrast, an open surgical procedure requires a large incision to access the area of interest. [[Laser surgery]] involves use of a [[laser]] for cutting tissue instead of a [[scalpel]] or similar surgical instruments. [[Microsurgery]] involves the use of an operating [[microscope]] for the surgeon to see small structures. [[Robotic surgery]] makes use of a surgical robot, such as the [[Da Vinci Surgical System|Da Vinci]] or the Zeus surgical systems, to control the instrumentation under the direction of the surgeon. ===Terminology=== *[[Excision]] surgery names often start with a name for the organ to be excised (cut out) and end in '''-ectomy'''. *Procedures involving cutting into an organ or tissue end in '''-otomy'''. A surgical procedure cutting through the [[abdominal]] wall to gain access to the [[abdominal cavity]] is a [[laparotomy]]. *[[Minimally invasive procedure]]s involving small incisions through which an endoscope is inserted end in '''-oscopy'''. For example, such surgery in the abdominal cavity is called [[laparoscopy]]. *Procedures for formation of a permanent or semi-permanent opening called a [[stoma]] in the body end in '''-ostomy'''. *Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in '''-oplasty'''. ''Rhino'' is used as a prefix for "nose", so ''[[rhinoplasty]]'' is basically reconstructive or cosmetic surgery for the nose. *Reparation of damaged or congenital abnormal structure ends in '''-rraphy'''. [[Herniorraphy]] is the reparation of a hernia, while perineorraphy is the reparation of [[perineum]]. ===Description of surgical procedure=== At a [[hospital]], modern surgery is often done in an [[operating room]] using [[surgical instrument]]s, an operating table for the patient, and other equipment. The environment and procedures used in surgery are governed by the principles of [[aseptic technique]]: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must be [[Sterilization (microbiology)|sterilized]], and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). OR staff must wear sterile attire ([[Scrubs (clothing)|scrubs]], a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure. Prior to surgery, the patient is given a [[medical examination]], certain pre-operative tests, and an [[ASA score]]. If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an [[autologous]] [[blood donation]] may be made some weeks prior to surgery. If the surgery involves the [[digestive system]], the patient may be instructed to perform a [[Whole bowel irrigation|bowel prep]] by drinking a solution of polyethylene glycol the night before the procedure. Patients are also instructed to abstain from food or drink (an [[Nil per os|NPO order]] after midnight on the night before the procedure, to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure. In the pre-operative holding area, the patient changes out of his or her street clothes and is asked to confirm the details of his or her surgery. A set of vital signs are recorded, a peripheral [[intravenous therapy|IV line]] is placed, and pre-operative medications (antibiotics, sedatives, etc) are given. When the patient enters the operating room, the skin surface to be operated on is cleaned and prepared by applying an [[antiseptic]] such as [[chlorhexidine gluconate]] or [[povidone-iodine]] to reduce the possibility of infection. If hair is present at the surgical site, it is clipped off prior to prep application. Sterile drapes are used to cover all of the patient's body except for the surgical site and the patient's head; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the [[anesthetist]]/[[anesthesiologist]]'s working area (unsterile) from the surgical site (sterile). [[Anesthesia]] is administered to prevent [[pain]] from incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided [[local anesthesia|locally]] or as [[general anesthesia]]. [[Spinal anesthesia]] may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the patient can remain conscious or minimally sedated. In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is [[intubation|intubated]] and is placed on a [[mechanical ventilator]], and anesthesia is produced by a combination of injected and inhaled agents. An incision is made to access the surgical site. [[Blood vessel]]s may be [[Surgical clamp|clamped]] to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then peritoneum. In certain cases, [[bone]] may be cut to further access the interior of the body; for example, cutting the [[skull]] for [[brain]] surgery or cutting the [[sternum]] for [[Thoracic surgery|thoracic (chest) surgery]] to open up the [[rib cage]]. Work to correct the problem in body then proceeds. This work may involve: *[[excision]] - cutting out an organ, tumor, or other tissue. *[[resection]] - partial removal of an organ or other bodily structure. *reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internal [[Suture|suturing]] or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called [[anastomosis]]. *[[ligation]] - tying off blood vessels, ducts, or "tubes". *[[Medical grafting|grafts]] - may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question. Although grafting is often used in cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area of the patient's body and inserted to another area of the body. An example is [[bypass surgery]], where clogged blood vessels are bypassed with a graft from another part of the body. Alternatively, grafts may be from other persons, cadavers, or animals. *insertion of [[Prosthesis|prosthetic]] parts when needed. Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometime a plate is inserted to replace a damaged area of skull. [[Artificial hip]] replacement has become more common. [[Heart pacemaker]]s or [[Heart valve|valves]] may be inserted. Many other types of [[Prosthesis|prostheses]] are used. *creation of a [[stoma (medicine)|stoma]], a permanent or semi-permanent opening in the body *in [[Organ transplant|transplant]] surgery, the donor organ (taken out of the donor's body) is inserted into the recipient's body and reconnected to the recipient in all necessary ways (blood vessels, ducts, etc.). *[[arthrodesis]] - surgical connection of adjacent bones so the bones can grow together into one. [[Spinal fusion]] is an example of adjacent [[vertebrae]] connected allowing them to grow together into one piece. *modifying the [[digestive tract]] in bariatric surgery for [[weight loss]]. *repair of a [[fistula]], [[hernia]], or [[prolapse]] *other procedures, including: :*clearing clogged ducts, blood or other vessels :*removal of calculi (stones) :*draining of accumulated fluids :*[[debridement]]- removal of dead, damaged, or diseased tissue *Surgery has also been conducted to separate [[conjoined twins]]. *[[Sex change operation]]s [[Blood transfusion|Blood]] or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete, [[suture]]s or [[Surgical staple|staples]] are used to close the incision. Once the incision is closed, the anesthetic agents are stopped and/or reversed, and the patient is taken off ventilation and extubated (if general anesthesia was administered). After completion of surgery, the patient is transferred to the [[post anesthesia care unit]] and closely monitored. When the patient is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. During the post-operative period, the patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way. Post-operative therapy may include adjuvant treatment such as [[chemotherapy]], [[radiation therapy]], or administration of [[medication]] such as anti-rejection medication for transplants. Other follow-up studies or rehabilitation may be prescribed during and after the recovery period. ==History== {{main|History of surgery}} At least two prehistoric cultures had developed forms of surgery. The oldest for which we have evidence is [[trepannation]],<ref>(Capasso 2001)</ref> in which a hole is [[drill]]ed or scraped into the [[skull]], thus exposing the [[dura mater]] in order to treat health problems related to intracranial pressure and other diseases. Evidence has been found in prehistoric human remains from [[Neolithic]] times, in [[cave painting]]s, and the procedure continued in use well into [[recorded history]]. Surprisingly, many prehistoric and premodern patients had signs of their skull structure healing; suggesting that many survived the operation. In modern-day [[Pakistan]], remains from the early Harappan periods of the [[Indus Valley Civilization]] (c. 3300 BC) show evidence of teeth having been drilled dating back 9,000 years.<ref>[http://news.bbc.co.uk/1/hi/sci/tech/4882968.stm BBC NEWS | Science/Nature | Stone age man used dentist drill<!-- Bot generated title -->]</ref> A final candidate for prehistoric surgical techniques is [[ancient Egypt]], where a [[mandible]] dated to approximately 2650 BC shows two perforations just below the root of the first [[molar (tooth)|molar]], indicating the draining of an abscessed [[tooth]]. Recent excavations of the construction workers of the [[Egyptian pyramids]] also led to possible evidence of [[brain surgery]].{{Fact|date=February 2007}} The oldest known surgical texts date back to ancient Egyptian about 3500 years ago. Surgeries were performed by priests, specialized in medical treatments similar to today. They documented their procedures on papyrus and were the first to describe patient case files which can nowadays be viewed in museums (i.e. Edwin Smith Papyrus). They medical expertise was later documented by Herodotus: "The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases." Herodotus, Histories 2,84 For more information see also http://nefertiti.iwebland.com/timelines/topics/medicine.htm Other ancient cultures to have surgical knowledge include [[ancient Greece]] - the [[Hippocratic Oath]] was an innovation of the Greek physician [[Hippocrates]] - and [[ancient China]]. However ancient Greek culture traditionally considered the practice of opening the body to be repulsive and thus left known surgical practices such as [[lithotomy]] to ''such persons as practice [it].'' In China, [[Hua Tuo]] was a famous Chinese physician during the Eastern Han and Three Kingdoms era. He was the first person to perform surgery with the aid of [[anesthesia]], albeit a rudimentary and unsophisticated form. In the [[Middle Ages]], surgery was developed to a high degree in the [[Islamic Golden Age|Islamic world]], with renowned [[Islamic medicine|practitioners]] such as [[Abulcasis]] (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an [[Al-Andalus|Andalusian-Arab]] physician and scientist who practised in the [[Zahra (Spain)|Zahra]] suburb of [[Córdoba, Spain|Córdoba]]. A great medieval surgeon, whose comprehensive medical texts shaped European surgical procedures up until the Renaissance. He is also often regarded as a Father Of Surgery.<ref>[http://www.famousmuslims.com/ABU%20AL-QASIM%20AL-ZAHRAVI.htm biography from Famousmuslims.com] accessed [[16 April]] [[2007]].</ref> In [[Europe]], the demand grew for surgeons to formally study for many years before practicing; universities such as [[Montpellier]], [[Padua]] and [[Bologna]] Universities were particularly renowned. By the fifteenth century at the latest, surgery had split away from [[physics]] as its own subject, of a lesser status than pure [[medicine]], and initially took the form of a [[craft tradition]] until [[Rogerius (physician)|Rogerius Salernitanus]] composed his ''Chirurgia'', laying the foundation for modern Western surgical manuals up to the modern time. Late in the nineteenth century, Bachelor of Surgery degrees (usually Ch.B.) began to be awarded with the [[Medical degree|(M.B.)]], and the mastership became a higher degree, usually abbreviated [[Master of Surgery|Ch.M. or M.S.]] in London, where the first degree was [[bachelor of medicine|M.B.,B.S.]]. Basic surgical principles for asepsis ect are known as [[Halsteads principles]] === Modern surgery === Modern surgery developed rapidly with the scientific era. [[Ambroise Paré]] (sometimes spelled "Ambrose"<ref>http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=1558689&dopt=Abstract : ''Historical notes on pressure ulcers: the cure of Ambrose Paré''</ref>) pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the [[Napoleonic Wars]]. Naval surgeons were often [[barber surgeon]]s, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches - control of [[bleeding]], control of [[infection]] and control of [[pain]] ([[anaesthesia]]). ; Bleeding: Before modern surgical developments, there was a very real threat that a patient would bleed to death before treatment, or during the operation. [[Cauterization]] (fusing a wound closed with extreme heat) was successful but limited - it was destructive, painful and in the long term had very poor outcomes. [[Ligature (medicine)|Ligatures]], or material used to tie off severed blood vessels, are believed to have originated with [[Abu al-Qasim al-Zahrawi|Abulcasis]]<ref>Rabie E. Abdel-Halim, Ali S. Altwaijiri, Salah R. Elfaqih, Ahmad H. Mitwall (2003), "''Extraction of urinary bladder described'' by Abul-Qasim Khalaf Alzahrawi (Albucasis) (325-404 H, 930-1013 AD)", ''Saudi Medical Journal'' '''24''' (12): 1283-1291 [1289].</ref> in the 10th century and improved by [[Ambroise Paré]] in the 16th century. Though this method was a significant improvement over the method of cauterization, it was still dangerous until infection risk was brought under control - at the time of its discovery, the concept of [[infection]] was not fully understood. Finally, early 20th century research into blood groups allowed the first effective blood transfusions. ; Infection: The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the [[Hungarian people|Hungarian]] doctor [[Ignaz Semmelweis]] who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the [[Royal Society]] in the UK still dismissed his advice. Significant progress came following the work of [[Louis Pasteur|Pasteur]], when the British surgeon [[Joseph Lister]] began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly reduce infection rates, a reduction that was further helped by his subsequent introduction of techniques to [[sterilization (microbiology)|sterilize]] equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in [[The Lancet]] (March 1867) under the title ''[[Antiseptic Principle of the Practice of Surgery]]''. The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime). ; Pain: Modern [[pain]] control through [[anesthesia]] was discovered by two [[United States|American]] [[Dentistry|dental surgeons]], Horace Wells (1815-1848) and William Morton. Before the advent of [[anesthesia]], surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient [[suffering]]. This also meant that operations were largely restricted to [[amputation]]s and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as [[diethyl ether|ether]] and [[chloroform]], later pioneered in Britain by [[John Snow (physician)|John Snow]]. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of [[muscle relaxant]]s such as [[curare]] allowed for safer applications. == Conditions treated by surgery == Surgery is used both as a treatment, and as an aspect of treatment, for many conditions, including: * [[Physical trauma]], e.g. [[wound]]s * Anatomical Abnormalities * Disorders of function * [[Inflammation]] * [[Ischemia|Ischaemia]] and [[infarction]] * [[Metabolic disease|Metabolic disorders]] * [[Neoplasia]] * Other abnormalities of tissue growth, e.g. [[cyst]]s, [[hyperplasia]] or [[Organ hypertrophy]], as well as some [[cancer]]s, if caught early enough * [[Deformity]] and heavy [[scarring]]. * [[Brain damage]] and [[nerve damage]] == Common procedures == Five of the most common surgical procedures in the [[United States]] are [[obstetrics|obstetric]]: [[episiotomy]], repair of obstetric [[laceration]], [[cesarean section]], and artificial rupture of the [[amnion|amniotic membrane]]{{Fact|date=May 2008}}. The most common non-obstetric surgical procedures include [[amputation]], [[appendectomy]], [[cataract surgery]], [[circumcision]], [[extraction (dental)|dental extraction]] and [[herniorraphy]]{{Fact|date=May 2008}}. According to 1996 data from the US [[National Center for Health Statistics]], 40.3 million inpatient surgical procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient operations. ==Surgical Specialties== *[[Cardiothoracic surgery]] *[[Colon and Rectal surgery]] *[[Dental Surgery]] *[[General surgery]] *[[Maxillofacial surgery]] *[[Neurological surgery]] *[[Ophthalmology]] *[[Orthopaedic surgery]] *[[Otolaryngology]] *[[Paediatric surgery]] *[[Plastic surgery]] *[[Podiatric surgery]] *[[Urology]] *[[Vascular surgery]] ==See also== <div style="-moz-column-count:4; column-count:4;"> *[[Anesthesia]] *[[ASA score]] or pre-operative physical fittness *[[Biomaterial]] *[[Cardiac surgery]] *[[drain (surgery)|Drain]] *[[Endoscopy]] *[[American College of Surgeons|FACS]] *[[Fellowship of the Royal College of Surgeons|FRCS]] *[[Royal Australasian College of Surgeons|FRACS]] *[[Royal Australasian College of Dental Surgeons|FRACDS]] *[[Royal College of Physicians and Surgeons of Canada|FRCS(C)]] *[[Royal College of Surgeons in Ireland|FRCSI]] *[[Royal College of Surgeons of Edinburgh|FRCS(Edin)]] *[[Membership of the Royal College of Surgeons|MRCS]] *[[Hypnosurgery]] *[[Knot]] *[[List of surgical procedures]] *[[Minimally invasive procedure]] *[[Perioperative mortality]] *[[Robotic surgery]] *[[Surgeon]] for surgeons' titles and list of famous practitioners *[[Trauma surgery]] *[[Surgical Sieve]] </div> ==References== {{reflist}} ==External links== * [http://www.manual-of-surgery.com/ The Thomson/Miles Manual of Surgery] * [http://journal.thecanadianmedz.org/plastic-surgery-greek-mythology/ Plastic surgery and Greek mythology] * [http://www.surgery-sugery.com/lasik-surgery.php Surgery Videos] * [http://www.or-live.com Watch Live Surgery (and past webcasts) at O.R. Live] * [http://www.surgeons.org.uk Surgeons Net Educational Site] * [http://slaptear.com/content/view/35/28/ Comparison of shoulder scars for open verses arthroscopic surgeries] * [http://www.imageofsurgery.com/Surgery_history_art.htm The portrayal of surgery by various artists] * [http://jdc.jefferson.edu/milsurgusa/ A Manual of Military Surgery, by Samuel D. Gross, MD (1861). The manual used by doctors in the Union Army during the American Civil War.] * [http://www.patentgenius.com/class/604.html United States Surgery Patents] * [http://www.americansurgical.info American Surgical Association] * [http://www.dlmag.com/1653/robot-successfully-completes-unassisted-heart-surgery.html Unmanned robot surgeon] * [http://www.aofoundation.org/wps/portal/surgeryskully AO Surgery Reference] * [http://www.surgicalsociety.org The Imperial College London Surgical Society] * [http://www.draligus.net/140-pediatric-surgery.htm Pediatric Surgery] {{Medicine}} {{Neurosurgical procedures}} {{Endocrine system operations and other procedures}} {{Eye surgery}} {{Operations and other procedures on the ear}} {{Operations and other procedures on the nose, mouth, and pharynx}} {{Respiratory system surgeries and other procedures}} {{Cardiac surgery}} {{Vascular surgery procedures}} {{Operations and other procedures of the hemic and lymphatic system}} {{Digestive system surgical procedures}} {{Urogenital surgical procedures}} {{Obstetrical procedures}} {{Operations and other procedures on the musculoskeletal system}} {{Operations and other procedures of the integumentary system}} [[Category:Surgery|*]] [[ar:جراحة]] [[ast:Ciruxía]] [[bn:শল্যচিকিৎসা]] [[bs:Hirurgija]] [[ca:Cirurgia]] [[cs:Chirurgie]] [[da:Kirurgi]] [[de:Chirurgie]] [[el:Χειρουργική]] [[es:Cirugía]] [[eo:Kirurgio]] [[eu:Kirurgia]] [[fr:Chirurgie]] [[ga:Máinliacht]] [[ko:외과]] [[hr:Kirurgija]] [[io:Kirurgio]] [[id:Bedah]] [[it:Chirurgia]] [[he:כירורגיה]] [[lv:Ķirurģija]] [[lt:Chirurgija]] [[hu:Sebészet]] [[mk:Хирургија]] [[nah:Texotlaticiliztli]] [[nl:Chirurgie]] [[ne:शल्यचिकित्सा]] [[new:शल्यचिकित्सा]] [[ja:外科学]] [[no:Kirurgi]] [[nds:Chirurgie]] [[pl:Chirurgia]] [[pt:Cirurgia]] [[ro:Chirurgie]] [[qu:Runa kuchuy]] [[ru:Хирургия]] [[simple:Surgery]] [[sk:Chirurgia]] [[sl:Kirurgija]] [[sr:Хирургија]] [[sh:Kirurgija]] [[fi:Kirurgia]] [[sv:Kirurgi]] [[th:ศัลยศาสตร์]] [[vi:Ngoại khoa]] [[tr:Cerrahi]] [[uk:Хірургія]] [[ur:جراحت]] [[zh:外科学]]