VERIFIED CONTENTAuthor: Krzysztof Bialazite

Contemporary surgery is developing at an impressive pace and its applications extend far beyond the limits of our imagination. Innovative surgical operations require access to highly specialized equipment and the possibility of training qualified staff. Discover 10 breakthrough surgical procedures that have changed the face of Polish and world medicine forever.

Surgery is one of the oldest and most demanding fields of medicine. Literally translated, "surgery" (Greek: cheir - hand, ergos - work) means "handicraft". Surgery is considered a kind of art by many doctors. Thanks to its development, it was possible to perform these unusual procedures.

First operation with anesthesia

Although it seems impossible today, the first surgical procedures were performed without the use of anesthesia. The prospect of having surgery without the accompanying pain seemed unrealistic. The path to pain relief in surgery began with herbal extracts, alcohol and opium, but the real breakthrough did not come until the 19th century. On October 16, 1846, the first successful operation with the use of general anesthesia was performed.

At the operating table stood the American doctor William Morton, who applied ether to his patient, and then performed surgery to remove the tumor from the neck area. Ether narcosis turned out to be effective - the patient woke up after the procedure and admitted that he felt no pain.

William Morton became one of the pioneers of modern anesthesiology. The news about the possibility of using anesthesia during surgery spread quickly around the world. In the same year, the first such procedure was performed in Europe - the British surgeon Robert Liston successfully used ether during the leg amputation procedure.

The first treatment with the use of ether in Poland was carried out a few months later - in February 1847 by professor Ludwik Bierkowski in Krakow. The invention of anesthesia was one of the milestones in the development of surgery. The procedures performed could be longer and more complex without harming patients. Dreams of painless operations have become a reality.

Transplanthearts

Heart transplantation is one of the most complex cardiac surgery procedures. Heart transplantation is the only treatment for advanced heart failure, a disease in which the heart muscle is too weak to pump blood to all parts of the body.

The procedure is performed with the use of extracorporeal circulation - the patient is connected to a special apparatus that oxygenates and pumps his blood. During this time, the patient's diseased heart is removed and the donor's heart is implanted in its place. It is necessary to properly combine all the dishes. The patient must take medication to prevent transplant rejection for the rest of his life.

The world's first successful heart transplant was performed in South Africa in 1967 by Professor Christiaan Barnard. At the end of the 1960s, the first attempts at heart transplantation were also made in Poland, but the successful surgery took place only in 1985. Its author was Professor Zbigniew Religa.

Currently, heart transplant surgery is performed more and more often in Poland (145 such procedures were performed in 2022). The main problem remains the small number of organ donors for transplantation. The list of people waiting for a heart transplant in Poland has over 400 patients.

Distance operation

Intercontinental surgical procedure using a medical robot? It sounds like a fantasy movie script, but it is a real event from the beginning of this century. Operation Lidbergh in question was performed on September 7, 2001. It was the first surgery performed fully remotely between two continents. A team of surgeons located in New York controlled the ZEUS medical robot, which operated on the patient on the operating table in Strasbourg (France).

The patient had her gallbladder removed and the entire operation was uneventful. Controlling the medical robot from such a large distance was possible thanks to the use of a special link based on fiber optic technology. Thanks to it, it was possible to minimize the delay in data transmission, and the entire operation lasted only 54 minutes.

The Lidbergh operation can be considered a breakthrough in remote surgery. "Remote" procedures can be used in a situation where the patient requires a complicated operation that can be performed by few specialists in the world.

Telesurgery allows the operator to connect with the patient without the need for physical contact. Unfortunately, despite the high hopes associated with this medical discipline, its main limitation is its high cost. The latest technologies and expensive equipment are needed for such operationsfunded mainly by research and remain inaccessible to most patients and doctors.

Whipple operation

Whipple surgery is one of the most extensive and complex surgical procedures in the abdominal cavity. The purpose of Whipple's surgery is to remove the head of the pancreas, gallbladder, duodenum and the antral part of the stomach.

After resection, it is necessary to restore the continuity of the gastrointestinal tract. The indications for the procedure are mainly pancreatic neoplasms. The procedure is named after Alan Whipple, an American surgeon distinguished in pancreatic surgery techniques.

Pancreatic cancer is one of the cancers with poor prognosis. The only chance to cure it is surgical removal of the tumor. Of all people suffering from pancreatic cancer, only 20-30% are eligible for surgery.

Despite the large extent of the surgery and the risk of complications, Whipple's surgery gives some patients a chance to heal. In Poland, Whipple's surgery is performed only in highly specialized oncological surgery centers.

Deep brain stimulation

Deep brain stimulation (DBS) is a method of surgical treatment of the advanced form of Parkinson's disease. DBS treatment involves implanting electrodes into the brain that improve the functioning of the areas responsible for the development of the disease.

The electrodes restore the balance between the activity of different groups of nerve cells, thanks to which the condition of patients with Parkinson's disease improves. Symptoms of tremors decrease, muscle stiffness becomes milder, and the frequency of involuntary movements decreases. Deep brain stimulation is a breakthrough procedure for patients in whom standard drug treatment is no longer effective.

The first DBS treatments were carried out in the 90s in France. Currently, they are performed all over the world, also in Poland. Deep brain stimulation has been developing dynamically in recent years. The operation belongs to the so-called stereotaxic procedures, i.e. those requiring very precise action.

The electrodes must be placed in a specific part of the brain. Based on the imaging studies, a map of the patient's brain is made, in which the target area is located. During the procedure, a special metal hoop is placed on the patient's head, which allows it to "hit" the right place and avoid damaging the nearby nervous tissue.

Other possible applications of this innovative operation are currently being investigated - incl. in the treatment of drug-resistant epilepsy and mental disorders.

Fetal surgery in the womb

Prenatal surgery is the field of surgery that deals with the operation of the fetus in the womb. The first attempts at intrauterine surgery were performed on animals at the end of the 19th century. The father of prenatal surgery is considered to be the American doctor Michael Harrison, who in 1981 performed a successful operation on a fetus with congenital hydronephrosis.

Since then, a lot of progress has been made in the field of intrauterine surgery. The effectiveness of this treatment method in relation to specific diseases was tested, staff were trained and the operating equipment significantly improved, thanks to which prenatal surgery is used worldwide today.

Intrauterine surgeries are used when it is impossible to wait until birth with the procedure. Some birth defects prevent the fetus from developing properly. Prenatal surgery offers a chance to repair them, which significantly increases the chance of safe delivery.

Currently, in Poland, intrauterine surgeries are performed in strictly defined diseases. Fetal operations are performed on some of the following:

  • congenital malformations of the nervous system (mainly meningeal hernias),
  • heart defects (including severe valvular defects),
  • urinary tract defects,
  • diaphragmatic hernia
  • and some neoplastic tumors.

These innovative treatments are mainly carried out in leading clinical hospitals with appropriately trained staff.

Face Transplant

The history of face transplant procedures did not start until the 21st century. The first patient in history to undergo a face transplant was French Isabelle Dinoire, who was bitten by a Labrador.

The treatment took place on November 27, 2005 in a clinic in Amiens (France). Face transplantation is one of the most complicated surgical operations. Apart from improving the appearance of the mutilated face, the aim is to preserve its functions (speech, eating, facial expressions). Face transplantation is performed using the most advanced microsurgical techniques.

In addition to medical care, patients undergoing facial transplantation require appropriate psychological support.

The first face transplant in Poland took place on May 15, 2013 in Gliwice and was an event widely publicized by the media. The procedure was performed by the Reconstructive and Vascular Surgery Team chaired by professor Adam Maciejewski.

The entire operation lasted 27 hours, and 14 surgeons were present at the operating table. The face transplant performed in Poland was unique becauseit was the first procedure of this type to be performed for life reasons. The success of Polish surgeons has been recognized all over the world.

The first face transplant in Poland became the inspiration for the film "The Face" by Małgorzata Szumowska from 2022.

Endoscopic Nose Brain Surgery

Operations with the use of endoscopes have many benefits for patients - they avoid the opening of body cavities, which significantly reduces the trauma associated with the surgery. Endoscopic surgery uses special equipment - a camera, a light source and surgical tools that are inserted into the body through natural openings.

Nowadays, endoscopy of the gastrointestinal tract (gastroscopy, colonoscopy) or respiratory tract (bronchoscopy) is already a standard performed in most hospitals. The uses of endoscopy, however, continue to expand.

This is evidenced by innovative brain surgeries performed through the nasal passages. This technique of surgery avoids opening the skull, which significantly shortens the patient's recovery time.

Through the nasal openings and then the paranasal sinuses, neurosurgeons are able to reach the base structures of the skull. This method works, among others in operating pituitary gland tumors. The pioneer of endoscopic brain surgery in Poland is the Department of Neurosurgery of the Medical University of Bialystok.

The first procedure of this type was carried out there in 2004. Endoscopic techniques in brain surgery are constantly evolving. Modern equipment allows you to enlarge the list of brain areas that can be reached in a minimally invasive manner. For patients, this means they can avoid major surgery and recover faster.

Pump in the heart

How can patients with severe heart failure be helped? Many of them qualify for heart transplant, but the limitation of this solution is the small number of donors and long waiting times. A breakthrough solution for this group of patients was the implantation of mechanical devices supporting the work of the heart.

In heart failure, the heart muscle is too weak to pump blood. Ventricular Assistance Systems (VADs) are mechanical pumps placed inside the heart to pump blood. This solution helps some patients survive the waiting time for a transplant, while for others it works so well that it may be a target treatment.

The first heart pump implantation operations were performed in the 1960s. Initially, they were a temporary solution for life-threatening patients. Over time, it turned out that the heart pumpsthey can successfully replace the work of a sick heart also for a long time. In the last 20 years, many cardiac surgery centers in our country have started to perform heart pump implantation.

The number of patients with advanced heart failure requiring such surgery is constantly growing. The techniques of operative heart function are constantly being improved. This is evidenced by the breakthrough surgery of July 4, 2022. On that day, for the first time in Poland, an effective procedure of implanting a completely artificial heart was performed in the patient at the Silesian Center for Heart Diseases in Zabrze.

Bariatric surgery

Bariatrics is a branch of surgery that deals with the surgical treatment of obesity. The goal of bariatric surgery is to change the anatomy of the gastrointestinal tract, leading to a reduction in the amount of food absorbed. Bariatric surgery is considered the most effective method of treating obesity grade III (BMI>40kg / m 2).

The development of bariatric surgery turned out to be a breakthrough for patients in whom the conservative treatment of obesity was ineffective. The first bariatric procedures were performed in the 1960s. Bariatric surgeries were performed in two ways: by reducing the volume of the stomach or by cutting out a part of the gastrointestinal tract and fixing the remaining sections properly.

Bariatric surgery came to Poland at the beginning of the 21st century. Currently, about 4,000 obesity surgical treatments are performed annually. The two most common types of bariatric procedures are sleeve gastrectomy and gastric bypass surgery. The first is to excise about 2/3 of the stomach.

Gastric bypass involves cutting through the stomach, making a small reservoir out of it, and then connecting it to the intestine. The condition for qualifying for a bariatric surgery is BMI>40 or BMI>35 and the presence of comorbidities (including diabetes, hypertension, ischemic heart disease).

The effectiveness of bariatric surgeries in long-term weight loss is estimated at about 80%. Bariatrics is therefore a breakthrough tool in the fight against morbid obesity, in which the effectiveness of conservative treatment (diet, physical activity) is only 5-10%.

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