शल्यचिकित्सा

thumb
**शल्यचिकित्सा** वा **शल्यक्रिया** छगु चिकित्सायागु ख्यः खः। थुकिलि ल्वे या घापाःयात अपरेसन याना लंकी। 

## इतिहास
### प्राचीन भारत
भारतीय चिकित्सक सुश्रुत (६०० बि सि) नं आ वाराणासी दुगु थासे शल्यक्रिया यायेगु व स्येनेगु ज्या यागु खने दु। वेकलं च्वयादिगु *सुश्रुत संहिता*नं वेकयागु शल्यक्रियायागु ज्ञानयु बारेय् येक्व खँ सीके छिं। थ्व सफू शल्यचिकित्सायागु दक्ले पुलाँगु सफू खः। थ्व सफूय् वेकलं येक्व ल्वेयागु बिस्तारय् जांच, डायग्नोसिस, उपचार, व प्रोग्नोसिसया वर्णन व प्लास्टिक सर्जरी, दसु- कस्मेटिक सर्जरी व राइनोप्लास्टीयागु वर्णन याना दिगु दु।

धन्वन्तरी नं न्ह्येथनादिगु आयुर्वेदिक ज्ञान दिवोदास यात वसपोलं स्येना दिल धाःसा दिवोदासं सुश्रुत, औपधेनव, औरभ्र, पौशकलावत, गोपुरारक्षित, व भोजयात स्येना दिल।

सुश्रुतयागु शल्यचिकित्साय् दुगु येक्व प्रारम्भिक योगदाअनयागु लागि वेकयात "शल्यचिकित्सायागु अबु" धका नं हनातगु दु। वेकयागु संहिताय् छुं भाग १गु शताब्दी तक्क्यागु नं खनेदु। अतः, छुं विषेशज्ञतेसं थ्व सफूय् मेमेपिं मनुतेगु नं योगदान दुगु विचाः तगु दु। सुश्रुत प्लास्टिक सर्जरी व कस्मेटिक सर्जरीयागु नं जन्मदाता खः। वेकयागु फोरहेड फ्ल्याप राइनोप्लास्टी (स्यंगु न्ह्याययात कपायागु छ्येंगु तया देकिगु) पद्दति अब्लेयागु अपराधयागु दण्ड कथं न्ह्याय चानाबीगु ज्या नं याना दयावल। थ्व पद्दति आयागु आधुनिक शल्यक्रियाय् नं छ्येलातगु दु। थ्व ज्ञान भारतय् १८गु शताब्दीयागु उत्तरार्ध तक्क नं दुगु खंयात अब्लेयागु जेन्टलम्यान्‌स्‌ म्यागाजिनं(अक्टोबर १७९४) पुष्टि यागु दु। 

सुश्रुत संहिताय् बावल स्वायेगु, प्रोस्ट्रेट ग्रन्थि लिकायेगु, क्याटार्‍याक्ट लेन्स लिकायेगु, एब्सेस पिकायेगु थें न्यागु खं च्वयातगु दु।

### प्राचीन मिश्र
अन्वेषकतेसं प्राचीन मिश्रय् २६५० बी सीयागु प्रथम मोलार वायागु जरायागु क्वे निगु हो दुगु म्यान्डिबल लुइकुगु दु। थुकिलिं एब्सेस दुगु वा लिकाइगु पद्दतियात ईंगीत याई। न्हुगु उत्खनन कथं पिरामिड देकुपिं ज्यामिय् न्ह्येपू शल्यक्रिया याना व ज्यामि नि दं लिपा तक्क म्वागु प्रमाण लुगु दु।

### प्राचीन युनान
आयागु ईले शल्यचिकित्सकतेत विशेष चिकित्सक धका हना तसां थ्व पेशायागु न्ह्येथनेज्या मेगु हे ख्यलं जुगु खः। युनानी संस्कृति कथलं मनुतेसं मनुयागु म्ह चायेके मज्यु, व हिपोक्र्याटिक शपथ नं चिकित्सकतेत शल्यचिकित्सा ज्यायात चेतावनी ब्युगु खने दु। विषेश कथलं, *cutting persons laboring under the stone* (अर्थात लिथोटोमी, "जलासेंयागु शल्यक्रियायागु ज्या व हे ज्याय् पोख्त मनुतेत त्वता बी मा" धैगु धारणा खने दु। शल्यचिकित्सायागु ज्ञान म्हयात बानास्वया जक्क वई, थ्व विज्ञान अब्लेयागु येक्व उसांयकमितेत मयगु खने दु।

### प्राचीन चीन
हुवा तुवो पूर्वी हान व स्वंगु राजशाही ई यागु छम्ह नांजाम्ह चिनियामि चिकित्सक खः। वेक एनेस्थेसिया छ्येला शल्यक्रिया यानादिम्ह दक्ले न्हापायाम्ह मनु खः। वेकलं आधुनिक चिकित्सा स्वया १६०० दं न्ह्य एनेस्थेसिया छ्येला दिगु खः।

### Medieval Europe
Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) was an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Cordova. He is considered a great medieval surgeon, whose comprehensive medical texts, combining Middle Eastern and Greco-Roman classical teachings, shaped European surgical procedures up until the Renaissance. He is often regarded as the Father Of Surgery. Patients and students from all parts of Europe came to him for treatment and advice.  According to Will Durant, Cordova was in this period the favourite resort of Europeans for surgical operations. 
thumb|right|225px|Surgery in Holland (ca. 1690)

By the thirteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Montpellier,  Padua  and Bologna Universities were particularly interested in the academic side to Surgery, and by the fifteenth century at the latest, Surgery was a separate university subject to Physics. Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius Salernitanus composed his *Chirurgia*, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.

### Europe

Ambroise Paré pioneered the treatment of wounds by gunshots.
Among the first modern surgeons were battlefield doctors in the Napoleonic Wars who were primarily concerned with amputation. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers.

In London, an operating theatre or operating room from the day before modern anaesthesia or antiseptic surgery still exists, and is open to the public.  It is found in the roof space of St Thomas Church, Southwark, London and is called the Old Operating Theatre.

### आधुनिक शल्यचिकित्सायागु विकास
आधुनिक ईले वेत शल्यचिकित्सायात स्वंगु मू बाधा पार याये माल। थ्व स्वंगु बाधा खः- 
* हि बाहा वनिगु
* संक्रमण
* स्याइगु

### Bleeding
Before modern surgical developments, there was a very real threat that a patient would bleed out on the table during an operation or bleed to death while being attended after an accident or wound. The first real progress in combating bleeding had come when early cultures realized they could close wounds using extremes of heat, a procedure called cauterizing. The early cauterization was successful, but only useable in a limited fashion, highly destructive, and painful, with terrible long term outcomes. 

The next real breakthrough to come was the invention of ligatures, something widely believed to have originated with Ambrose Pare during the 16th century. A ligature is a piece of material used to tie closed the end of a cut blood vessel preventing any further bleeding by serving to occlude it. Ligatures form the basis of modern control bleeding, but at the time, they were more of a hazard than a help because the surgeons using them had no concept of infection control.

A final barrier to be overcome was the problem of replacing blood lost. Limiting bleeding is important, but ultimately, a surgeon is fighting a losing battle if blood cannot be replaced, and this final barrier was only conquered when early 20th century research into blood groups allowed the first effective blood transfusions.

### Infection
Big holes into sealed internal environments lead to infections, especially if the surgeon is using dirty tools, covered in blood and wearing his normal clothes. The first progress in combating infection was made by the Hungarian doctor Semmelweiss who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweiss, 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. 
The next true progress came when, after reading a paper by Louis Pasteur, the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly improve infection rates no end, a process that was further helped by his subsequent introduction of techniques to sterilise 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). The gradual development of germ theory has allowed the final step to be taken to create the highest quality of aseptic conditions in modern hospitals and this has allowed us to (theoretically) perform infection free surgery.

### Pain
Anesthesia was discovered by two American dentists, 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 amputations 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 ether and chloroform. In Britain, John Snow pioneered the use of these two anaesthetics. 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 relaxants such as curare allowed for safer applications.

### Doctor or Mister?
In the United Kingdom, Australia, South Africa and New Zealand surgeons are distinguished from physicians by being referred to as "Mister."  This tradition has its origins in the 18th century, when surgeons were barber-surgeons and did not have a degree (or indeed any formal qualification), unlike physicians, who were doctors with a university medical degree.

By the beginning of the 19th century, surgeons had obtained high status, and in 1800, the Royal College of Surgeons (RCS) in London began to offer surgeons a formal status via RCS membership. The title *Mister* became a badge of honour, and today only surgeons who are Fellows of the Royal College of Surgeons generally call themselves Mister, Miss, Mrs or Ms in the course of their professional practice. 

By contrast, North American physicians and surgeons are always addressed as "Doctor." The title of doctor is represented in a physician and surgeon's name by the title  M.D., D.O., D.P.M , D.D.S., or D.M.D. following his/her surname.

## शल्यचिकित्सा नं लनिगु ल्वेत
* हर्निया
* पत्थरी (पित्त व मूत्र थैली)
* घापाः
* एनाटोमिकल असामान्यता
* इस्केमिया व इन्फार्‍क्सन
* नियोप्लेसिया
* मेमेगु असामान्य तन्तु, दसु सिस्ट, हाइपरप्लेजिया वा अंग हाइपरट्रफी

## सामान्य शल्य प्रक्रियात

* संयुक्त राज्य अमेरिकाय् दक्ले अप्व याइगु च्यागु शल्यक्रियाय् प्येंगु अब्स्टेट्रिक ला:
** इपिजियोटोमी,
** अब्स्टेट्रिक (मचा बुइकिबिलेयागु) घापायागु उपचार,
** सिजरियन सेक्सन, व
** एम्नियोटिक मेम्ब्रेनयागु आर्टिफिसियल रप्चर

* गैह्र अब्स्टेट्रिक शल्यप्रक्रियाय् क्वे बियातगु मू खः:
** एम्प्युटेसन
** एपेन्डेक्टोमी
** सर्कमसिजन
** डेन्टल एक्स्ट्र्याक्सन
** हर्नियोर्‍याफी

१९९६यागु अमेरिकी उसायं तथ्यांकयागु राष्ट्रिय केन्द्रकथलं, अमेरिकाय् ४०.३ मिलियन इन्पेसेन्ट सर्जिकल प्रक्रिया जुल धाःसा ३१.५ मिलियन आउटपेसेन्ट अपरेसन जुल।

## नांजापिं शल्यचिकित्सकत
* सुश्रुत (known as "father of surgery", inventor of plastic surgery)
* विलियम स्टेवार्त हाल्स्टेड (initiated surgical residency training in U.S., pioneer in many fields)
* अल्फ्रेड ब्लालक (first modern day successful open heart surgery in 1944)
* सी. वाल्टन लिल्लेहेइ (labeled "Father of modern day open heart surgery")
* क्रिस्टियन बर्‍नार्‍ड (cardiac surgery, first heart transplantation)
* वाल्टर फ्रीम्यान (lobotomy)
* जोन हन्टर  (Scottish, viewed as the father of modern surgery, performed hundreds of dissections, served as the model for Dr. Jekyll.)
* सर भिक्टर होर्‍स्ले (neurosurgery)
* लार्स लेक्सेल (neurosurgery, inventor of radiosurgery)
* जोसेफ लिस्टर (discoverer of surgical sepsis, Listerine named in his honour)
* हार्भी कुशिङ्ग (pioneer of brain surgery)
* जोसेफ प्यान्कोस्ट - 19th century American surgeon
* नोर्‍म्यान बेथ्युन - Canadian thoracic surgeon, early proponent of universal health care and inventor of the first practical mobile blood transport unit.
* ग्याभ्रिक लिजारोभ - Russian orthopedic surgeon who invented the procedure to lengthen or reshape limb bones.
* स्भ्याटोस्लाभ फ्योडोरोभ - Russian ophthalmologist, eye microsurgeon, creator of radial keratotomy.
* गाजी यसर्‍गील - Turkish neurosurgeon, honored as the Neurosurgeon of the Century in 1999 by the Journal of Neurosurgery
* राध्यापक डाक्टर रमा कान्त - honoured with International World Health Organization (WHO) Award in the year 2005 has pioneering innovations in cardiothoracic surgery, and heads Surgery Department at King George's Medical University

## शल्यक्रियायागु पद्धति व प्रविधि
* सर्जिकल प्रोसेड्युरतेगु धलः
* एब्डोमिनल सर्जरी
* कार्डियोथोर्‍यासिक सर्जरी
* डेन्टल सर्जरी
* जेनेरल सर्जरी
* ल्यापारोस्कोपिक सर्जरी
* न्युरोसर्जरी
* अप्थ्याल्मिक सर्जरी
* ओरल व म्याक्जिल्लोफेसियल सर्जरी
* अर्थोपेडिक सर्जरी
* ओटोराइनोल्यारिंगोलोजी
* प्लास्टिक सर्जरी
* रिमोट सर्जरी
* युरोलोजी
* भास्कुलर सर्जरी

## स्वया दिसँ
* एनेस्थेसिया
* बायोम्याटेरियल
* ड्रेन
* एन्डोस्कोपी
* FACS
* हिप्नोसर्जरी
* चिकित्सा
* मिनिमल्ली इन्भेसिभ प्रोसेड्युर
* ट्रउम्याटोलोजी

## पिनेयागु स्वापूत
* शल्यक्रियायागु शैक्षिक थाय्
* Comparison of shoulder scars for open verses arthroscopic surgeries
*  The portrayal of surgery by various artists
*  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.
* An On-Line Surgery Journal Club (via JournalReview.org)
* United States Surgery Patents
* American Surgical Association
* Unmanned robot surgeon
* AO Surgery Reference
* The Imperial College London Surgical Society

पुचः:चिकित्सा