The History and Evolution of Surgical Instruments

The saying goes “A bad workman blames his tools.” This may be true, but a good surgeon relies on his tools to be sharp, safe, and effective. Have you ever wondered how these vital surgical tools developed?

History of Surgical Instruments

It might be surprising, but there’s evidence that surgeons evolved earlier than previously expected.  Ancient skeletons found in France from the year 6500 BC show signs of trepanning. And even ancient Egyptian skeletons show signs of having undergone surgery (and survived for a while afterward!)

Surgery is an ancient art

Later, the ancient Greeks set broken bones, amputated injured limbs, and used lancets and heated cups to draw blood from boils. Ancient Romans also used tools to remove goiters and polyps. By the Middle Ages, barber-surgeons were able to remove cataracts from the eye and stones from the bladder. But since they didn’t yet know about sepsis, most patients died from infection.

Early “surgeons” needed tools for these tasks. Without stainless steel or autoclaves, they just used what they had on hand – literally! The earliest doctors used their teeth, fingers, and fingernails. Later, they used sharp stones like flint, then iron and steel. But what might surprise you is that early use of fingers and teeth for surgery are what shaped the advanced instruments that are still used today.

• Cutting and dissecting tools like surgical scissors replaced the job of fingernails and teeth.
• Clamps and holders replaced the pinching and grasping motion of the fingers and thumb, or the clenching action of the teeth.
• Retracting and dilating tools replaced the fingers pulling and opening up incisions and wounds.
• Staples and sutures are now used instead of the fingers and teeth to hold cut edges of tissue together.
• Sucking and aspirating tools took the place of the action of the mouth to suck out fluid.

Medieval method to filter infected air (source: 17th-century engraving)

Modern surgical tools

In the late-19th and early-20th centuries, the evolution of surgical tools took a leap forward. The abdomen, the thorax, and the cranium had previously been off-limits – and for good reason! But when surgeons discovered anesthesia and asepsis, they could really enjoy themselves and get to work on the innermost areas of the body. Operating on new body parts meant that surgeons needed new tools and to refine the use of old ones. Surgical scissors, surgical forceps, surgical tweezers, and surgical scalpels were improved for delicate use in the inner thoracic cavity, the brain, and the abdomen.

Getting closer…

The 1920s saw another big change with the introduction of surgical scalpels with disposable blades. They quickly became the most popular choice for maintaining sharpness and reducing the risks of infection. The mid-20th century also saw the discovery of new materials for surgical tools. Steel was still the most popular material for surgical tools, but chrome, titanium, and vanadium came into fashion for lightweight, hard-wearing, precision surgical instruments. Small yet strong surgical tools manufactured from titanium alloys made ophthalmological, neurological, and otological microsurgical procedures possible. 

The most recent innovations for surgical instruments

The late 20th century brought some of the biggest advances in surgical tools. First came electronic surgical tools, like endoscopic and laparoscopic surgical tools, electrocauteries, ultrasound, electric surgical scalpels, arthroscopic shavers, and other powered surgical instruments. Next, surgeons saw the power of combining computers with surgery. Computer-guided endoscopic surgery is becoming widespread for heart surgery, neurology, urology, gynecology, and thoracic surgery. Connecting computers to specially adapted surgical instruments means that the surgeon’s actions can be carried out in a tiny area, enabling actions that can’t be done by the human hand alone.

The future of surgical tools

It’s hard to predict the future, but many people see robots taking over in the operating theater. Robotic-assisted surgery is already becoming popular across the US, and surgeons are still discovering its potential.

Is this the future?

Prehistoric “surgeons” wouldn’t recognize a robotic-assisted surgical scalpel, but it still originates in their use of teeth and nails. Even while robots push the boundaries of surgical tools, they still owe a debt to the very first “surgeons”.