THE TOP 10 SURGICAL ADVANCES OF THE LAST 70 YEARS

THE ANESTHESIA CONSULTANT
THE ANESTHESIA CONSULTANT
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Anesthesiologists work with surgeons of every specialty. Remarkable surgeons made world-changing breakthroughs during the past 70 years. The top 10 surgical advances during this time included:

• THE HEART-LUNG MACHINE
• ARTHROSCOPY
• HEART TRANSPLANTATION
• THE FIBEROPTIC ENDOSCOPE
• VIDEOLAPAROSCOPY
• INTERVENTIONAL RADIOLOGY/ANGIOPLASTY/STENTS
• LIVER TRANSPLANTATION
• TOTAL JOINT REPLACEMENT
• LASIK
• TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)

 

THE LIST . . . IN ROUGHLY CHRONOLOGIC ORDER:

• THE HEART-LUNG MACHINE AND OPEN HEART SURGERY. Inventor: Dr. John Gibbon (1950s). The heart-lung machine made coronary artery bypass surgery and open heart surgery possible. Prior to the machine, it was impossible to successfully operate on the heart while it was still beating. The invention of the cardiopulmonary bypass pump, or heart-lung machine, allowed blood to bypass the heart during surgery. The machine is attached to the veins that enter the heart and to the arteries that exit the heart. The machine then extracts blood from the patient, adds oxygen to it and pumps it back around the body, ensuring that all the organs receive oxygen while the heart is stopped. Dr. Gibbon carried out his initial research using cats and dogs. In 1953 he performed the first successful operation on a human using the heart-lung machine. In the 1980s researchers found that by cooling the heart to below 28°C and treating it with cardioplegic chemicals, the heart could be stopped for hours while complex surgeries were performed. The heart could then be restarted with minimal damage.

Heart-Lung Machine

 

• ARTHROSCOPY. Dr. Inventor: Dr. Masaki Watanabe (1960s- 1980s). The Japanese orthopedic surgeon Dr. Watanabe is widely considered the father of modern arthroscopy.  In 1962 he performed the first arthroscopic knee surgery and meniscectomy using instruments he developed. Watanabe developed his arthroscope from a pediatric cystoscope. Prior to the arthroscope, this surgery required the surgeon to open the joint to operate directly on the meniscus. Six weeks after this first arthroscopy, the patient was playing basketball.  In 1965 Dr. Robert Jackson brought the technique from Japan to the Toronto General Hospital in North America.

Arthroscope

 

• HEART TRANSPLANTATION. Inventor: Dr. Norman Shumway (1960s-1980s). Dr. Shumway spent decades working on the science of heart transplantation in the dog laboratory. In 1959 Shumway successfully performed the first dog heart transplantation. On November 20, 1967 Shumway announced that Stanford was ready to perform the first human heart transplant. Two weeks later South African surgeon Dr. Christiaan Barnard surprised Shumway and the entire world by using Shumway’s surgical technique to perform the first human heart transplant. The patient lived only 18 days. On January 6, 1968, Shumway performed the first successful heart transplant in America at Stanford University Hospital. Shumway’s program grew in the 1980s after the discovery of the immunosuppressive drug cyclosporine, which decreased the transplant rejection rate and improved survival. In 2023, 110 hospitals in the U.S. performed heart transplantation, and the procedure is saving lives of patients with severe cardiomyopathies.

Norman Shumway operating in the heart room at Stanford

 

• THE FIBEROPTIC ENDOSCOPE. Inventors: Dr. Larry Curtis and Dr. Basil Hirschowitz (1950s – 1960s). Prior to 1960, views into the colon or upper gastrointestinal tract were only possible via rigid metal tubes. In the late 1950s, Larry Curtiss and Dr. Basil Hirschowitz invented a modern optical fiber scope at the University of Michigan. In 1960 the first commercial fiberoptic endoscope, the American Cystoscopy Makers Model 4990, was introduced. The flexible fiberoptic endoscope revolutionized the practice of gastroenterology, and enabled physicians to visualize the colon, esophagus, stomach, and duodenum—locations previously only visible to a surgeon or a pathologist.

Dr. Hirschowitz and the first fiberoptic gastroscope

 

• VIDEOLAPAROSCOPY. Inventor: Dr. Camran Nezhat (1970s-1980s). Dr. Nezhat is widely recognized as the father of operative videolaparoscopy, a technique which revolutionized noninvasive surgery. During his gynecology residency, Dr. Nezhat was exposed to laparoscopy as a diagnostic tool. In the late 1970s he began using a video camera rigged to the end of the laparoscope for animal surgeries. He introduced the technique of operating while watching video camera images on a television monitor, rather than placing a single eye onto the end of an endoscope. Nezhat perfected laparoscopic operative repairs for management of multiple diseases of the pelvis and abdomen, and demonstrated the advantages of laparoscopic surgery: shorter hospital stays, smaller incisions, and faster recovery. He also showed that, when performed by an experienced surgeon, laparoscopic surgery is associated with fewer complications and better results than open laparotomy.

Dr. Nezhat operating with a laparoscope while watching the video monitor

 

• INTERVENTIONAL RADIOLOGY CATHETER PROCEDURES. Inventor: Dr. Andreas Grüntzig (1970s). Atherosclerosis in arterial blood vessels represents a major cause of illness and death in the world. In 1974 German-born Dr. Andreas Grüntzig first utilized a balloon-tipped catheter to reopen a narrowed femoral artery, a procedure he initially called “percutaneous transluminal dilatation.”  His first successful coronary angioplasty dilation on an awake human was performed in 1977 in Switzerland. He expanded a stenosed 3 mm non-branching section of the left anterior descending coronary artery. Balloon angioplasty replaced many open coronary artery bypass surgeries, and along with intravascular stenting became the method of choice to treat patients with significant coronary artery disease. The same technology is useful to treat patients with occluded leg arteries. Interventional radiology procedures on the brain and other organs have expanded this realm into new surgical subspecialties.

The Grüntzig balloon catheter principle

 

  • LIVER TRANSPLANTATION. Inventor: Thomas Starzl MD PhD (1960s-1980s). Dr. Starzl conducted more than 150 dog experiments on liver transplantation between 1958-1961. He performed the first attempted human liver transplant in1963, but the patient died intraoperatively due to uncontrolled bleeding. In 1967 Starzl performed a liver transplant on a 19-month-old girl who survived for over one year. In the 1980s, with the addition of cyclosporine immunosuppression for his transplant patients, Starzl’s program at the University of Pittsburgh established liver transplantation as a viable option to treat end-stage liver failure. In 1989 the New England Journal of Medicine (321:1014-1022, 1989; 321:1092-1099, 1989) stated: “The conceptual appeal of liver transplantation is so great that the procedure may come to mind as a last resort for virtually every patient with lethal hepatic disease.” As liver transplantation became widespread, almost every liver program director could trace their educational background to Dr. Starzl.

Dr. Starzl and his liver transplant team at the University of Pittsburgh

 

• TOTAL JOINT REPLACEMENTS. Inventor: Dr. John Charnley (1960s-1980s). He was born in England in 1911, and was trained as a general surgeon. During World War II he was stationed as an orthopedic officer in Cairo, where he invented a variety of surgical instruments. After the war he became a consultant orthopedic surgeon in England. He performed experiments on joint function, directed at understanding the friction and lubrication of animal and artificial joints. He tested a new material: ultra-high molecular weight polyethylene (UHMWP), which had the favorable qualities of excellent wear resistance, low friction, and high impact. In 1962 Charnley inserted the first UHMWP socket into a hip joint. He also introduced the use of methyl methacrylate as a plastic cement to firmly affix prosthetic components to the bone. His pioneering work on joint prosthetics changed orthopedic surgery forever.

 

• LASIK (Laser-Assisted in Situ Keratomileusis) Inventors: Dr. Gholam Peyman and Dr. Ioannis Pallikaris (1980s-1990s). In 1989 Dr. Peyman received a patent for his method of modifying the corneal curvature of the eye with a laser surgical procedure in which a flap was cut in the cornea, the flap was pulled back to expose the corneal bed, the exposed surface was ablated, and the flap replaced. Using this technique, Dr. Pallikaris performed the first laser-assisted in situ keratomileusis (LASIK) in 1992. LASIK became a popular refractive surgery which produced immediate vision correction with few side effects. LASIK is currently the world’s most popular elective surgical procedure, as more than 28 million LASIK surgeries have been performed worldwide.

 

• TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR). Inventors: Dr. Henning Rud Andersen and Dr. Alain Cribier (1989-2000s).  Dr. Alain Cribier performed the first catheter valve implantation in a human in France in 2002.  Prior to the TAVR procedure, replacement of a heart valve required general anesthesia, a heart-lung bypass machine and open heart surgery, to enable a surgeon to directly sew a new valve prosthesis into place. The development of TAVR enabled replacement of the aortic valve via a femoral artery approach, and significantly improved safety and patient outcomes. TAVR use has expanded so that it’s now a mainstream treatment for aortic valve disease. The 30-day mortality after TAVR has decreased from 7.2% to 2.5%, and the incidence of stroke has fallen from 2.75% to 2.3%.  Highly trained cardiologists can now replace any of the four heart valves via a similar transcatheter technique, and some replacements can be done via the radial artery rather than using the femoral artery.

TAVR heart surgery

 

These are the 10 biggest leaps in surgical history in the past 70 years, as seen through the eyes of this anesthesiologist. It’s been a remarkable era in medicine, and one can only speculate if the next 70 years can possibly bring an equivalent revolution in the practice of surgery.

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