There are many reasons to have surgery. Some operations can relieve or prevent pain. Others can reduce a symptom of a problem or improve some body function. Some surgeries are done to find a problem. For example, a surgeon may do a biopsy, which involves removing a piece of tissue to examine under a microscope. Some surgeries, like heart surgery, can save your life.

Some operations that once needed large incisions (cuts in the body) can now be done using much smaller cuts. This is called laparoscopic surgery. Surgeons insert a thin tube with a camera to see, and use small tools to do the surgery.

After surgery there can be a risk of complications, including infection, too much bleeding, reaction to anesthesia, or accidental injury. There is almost always some pain with surgery.

Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows a surgeon to see images of the body's internal structures through very small incisions.

Endoscopic surgery has been used for decades in a number of different procedures, including gallbladder removal, tubal ligation, and knee surgery.

The endoscope

An endoscope consists of two basic parts: A tubular probe fitted with a tiny camera and bright light, which is inserted through a small incision; and a viewing screen, which magnifies the transmitted images of the body's internal structures. During surgery, the surgeon watches the screen while moving the tube of the endoscope through the surgical area.

It's important to understand that the endoscope functions as a viewing device only. To perform the surgery, a separate surgical instrument--such as a scalpel, scissors, or forceps--must be inserted through a different point of entry and manipulated within the tissue.

Advantages of endoscopy

All surgery carries risks and every incision leaves a scar. However, with endoscopic surgery, scars are likely to be much smaller and some of the after effects of surgery may be minimized.

In a typical endoscopic procedure, only a few small incisions, each less than one inch long, are needed to insert the endoscope probe and other instruments. For some procedures, such as breast augmentation, only two incisions may be necessary. For others, such as a forehead lift, three or more short incisions may be needed. The tiny "eye" of the endoscope's camera allows a surgeon to view the surgical site almost as clearly as if the skin were opened from a long incision.

Because the incisions are shorter with endoscopy, the risk of sensory loss from nerve damage is decreased. Also, bleeding, bruising and swelling may be significantly reduced. With the endoscopic approach, recovery may be quicker than that of an open surgery.

Endoscopic surgery may also allow you to avoid an overnight hospital stay. Many endoscopic procedures can be performed on an outpatient basis under local anesthesia with sedation. Patients should discuss this possibility with their doctor.

Laparoscopic surgery is surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Also called laparoscopic-assisted resection.

An "open" surgery is one in which the patient is cut open. A typical open surgery involves the use of a scalpel (see scalpel) to make an incision into the skin and cut through the various layers of the dermis and sub-dermal layers and tissues to get to the desired tissue or organ. Some open surgeries use a laser to make the incision.

Physicians and surgeons diagnose and treat injuries or illnesses and address health maintenance. Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests. They often counsel patients on diet, hygiene, and preventive healthcare. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.

There are two types of physicians, with similar degrees: M.D. (Medical Doctor) and D.O. (Doctor of Osteopathic Medicine). Both use the same methods of treatment, including drugs and surgery, but D.O.s place additional emphasis on the body's musculoskeletal system, preventive medicine, and holistic (whole-person) patient care. D.O.s are most likely to be primary care physicians, although they work in all specialties.

Physicians often work closely with other healthcare staff including physician assistants, registered nurses, and medical records and health information technicians.

Duties

Physicians and surgeons typically do the following:

• Take a patient’s medical history and perform a physical exam
• Document and update charts and patient information to show findings and treatments
• Order tests and consultations for other physicians or healthcare staff to perform
• Review test results to identify abnormal findings
• Recommend, design, and implement a treatment plan
• Address concerns or answer questions that patients have about their health and well-being
• Help patients take care of their health by discussing topics such as proper nutrition and hygiene

Physicians and surgeons focus on a particular type of practice. Within their area of focus, they also may specialize or subspecialize. The following are examples of types of physicians and surgeons:

Anesthesiologists focus on the care of surgical patients and on pain relief. They administer drugs (anesthetics) that reduce or eliminate the sensation of pain during an operation or another medical procedure. During surgery, they adjust the amount of anesthetic as needed and monitor the patient's heart rate, body temperature, blood pressure, and breathing. They also provide pain relief for patients in intensive care, for women in labor, and for patients suffering from chronic pain.

Cardiologists diagnose and treat diseases or conditions of the heart and blood vessels, such as valve problems, high blood pressure, and heart attacks. Cardiologists may work with adults or specialize in pediatrics (typically newborns through age 21). Although they treat many of the same disorders in either population, cardiologists in pediatric care focus on conditions that patients are born with rather than on those that develop later in life.

Dermatologists provide care for diseases relating to the skin, hair, and nails. They treat patients who may have melanoma or other skin cancers. They may offer both medical and surgical dermatology services.

Emergency medicine physicians treat patients in urgent medical situations. These physicians evaluate, care for, and stabilize patients whose illness or injury requires immediate attention. Unlike many other physicians, who often choose to specialize, most emergency medical physicians are generalists.

Family medicine physicians are generalists who address health maintenance and assess and treat conditions that occur in everyday life. These conditions include sinus and respiratory infections, intestinal ailments, and broken bones. Family medicine physicians typically have regular, long-term patients, who may include all members of the same household.

General internal medicine physicians diagnose and provide nonsurgical treatment for a range of problems that affect internal organs and systems such as the stomach, kidneys, liver, and digestive tract. Internists use a variety of diagnostic techniques to treat patients through medication or hospitalization. Their patients are mostly adults. They may specialize, such as in gastroenterology or endocrinology.

Neurologists diagnose and treat those with disorders of the brain and nervous system, such as Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), and epilepsy. These physicians may specialize in one or more conditions, or they may work as pediatric neurologists to diagnose and manage the care of children with autism, behavioral disorders, or other neurological conditions.  

Obstetricians and gynecologists (OB/GYNs) provide care and counsel to women regarding pregnancy, childbirth, and the female reproductive system. They also diagnose and treat health issues specific to women, such as cervical cancer, ovarian cysts, and symptoms related to menopause.

Ophthalmologists diagnose and treat conditions of the eye. Treatment may include surgery to correct vision problems or to prevent vision loss from glaucoma and other diseases. Ophthalmologists also may fit eyeglasses, prescribe contact lenses, and provide other vision services.

Orthopedic surgeons diagnose and treat conditions of or injuries to the musculoskeletal system, which includes bones, muscles, ligaments, and tendons. They may specialize in certain areas of the body, such as the foot and ankle, or in a particular type of practice, such as sports medicine.

Pathologists test body tissue, fluids, and organs and review test results to diagnose diseases. These physicians may choose specializations that include clinical pathology, which focuses on laboratory analysis of bodily fluids, and anatomical pathology, which focuses on examinations of tissue and other samples acquired through autopsy or surgery.

Pediatricians provide care for infants, children, teenagers, and young adults. They specialize in diagnosing and treating problems specific to younger people. Most pediatricians administer vaccinations and treat common illnesses, minor injuries, and infectious diseases. Some pediatricians specialize in serious medical conditions that commonly affect younger patients, such as autoimmune disorders.

Pediatric surgeons diagnose, treat, and manage a variety of disorders and diseases in fetuses, infants, children, and adolescents. These surgeons collaborate with physicians involved in a child’s medical care—including neonatologists, pediatricians, and family medicine physicians—to determine the best treatment options for the child.

Psychiatrists are primary mental health physicians. They diagnose and treat mental illnesses through a combination of personal counseling (psychotherapy), psychoanalysis, hospitalization, and medication. Psychotherapy involves psychiatrists helping their clients change behavioral patterns and explore past experiences. Psychoanalysis involves long-term psychotherapy and counseling. Psychiatrists may prescribe medications to correct chemical imbalances that cause some mental illnesses.

Radiologists review and interpret x rays and other medical images, such as ultrasounds, to diagnose injuries or diseases. They may specialize, such as in diagnostic radiology, which involves reviewing images and recommending treatment or additional testing, or in interventional radiology, which includes diagnosing patients and treating them with minimally invasive techniques.

Physicians in healthcare establishments work daily with other healthcare staff, such as registered nurses, other physicians, medical assistants, and medical records and health information technicians.

Some physicians choose to work in fields that do not involve patient care, such as medical research or public policy.

Before having surgery, many people want to know what will happen to them and what kind of results they can expect. Although doctors are required to provide this information, people are often left feeling that they still don’t know enough. But getting all the facts is very important if a decision needs to be made.

There is usually a good reason for having surgery. The procedure might be able to improve or restore your health, or even save your life. But it can also have disadvantages. People considering the possible risks before an operation may feel unsure and wonder things like whether the operation is really necessary, what will happen if they don't have the operation, how the surgery will affect them – and how they can cope better afterwards.

Others prefer to trust that the surgery will be successful and not worry about it too much.

What can help relieve anxiety before surgery?

Surveys have shown that most people don’t feel they have enough information before surgery. As a result, many don’t feel confident about the decision they have made, and they may have doubts.

The amount and type of information people want varies a lot from person to person: Some people want to know exactly what is going to happen during and after a procedure or operation. Others would prefer to be told about what they will see and feel. Many would like advice about how to cope with these situations. So it may be a good idea to do the following things ahead of time:

• Get information: Knowing what will happen during the operation can reduce uncertainty.
• Plan: You might want to talk with your doctors and nurses about the type of pain therapy and follow-up care you will have.

Having enough information can help you feel safer. Knowing what other treatments are available and how they compare with the planned procedure may also be helpful.

Last, but not least, every patient has the right to get a second opinion from a different doctor – in other words, to ask them for advice and perhaps be examined again.

Information and decision aids

One of doctors’ responsibilities is to inform patients about what will happen during a procedure and explain the risks. When preparing for doctor’s appointments, it’s a good idea to make a list of questions you may have about the surgery.

Because it isn’t always possible for the doctor to answer all of the questions, many people end up looking for more information afterwards. There are many different sources of medical information – including leaflets, books, films, websites or Internet forums – but the information is often contradictory, confusing or simply wrong. Some of it may even end up scaring you or making you feel even more anxious.

There are also decision aids for people with certain illnesses – on paper or online. These usually contain information and questions that can help you find out what is important for you, personally. Decision aids concerning surgery may, for instance, present the advantages and disadvantages of an operation and help you realize how important they are to you. Once you have a clear idea of your own wishes, values and expectations, it can be easier to make the right decision – or to reassure yourself that you have made the correct decision. However, structured decision aids are only available for a few illnesses, so doctors don’t often give them to their patients.

Other things that may be important before surgery

Having a talk with the doctor before surgery can give you the opportunity to discuss and make arrangements concerning things that may be on your mind, such as:

• which medications you should stop taking before the operation, such as medication for chronic diseases,
• how long before having the anesthetic and after surgery you shouldn’t eat, drink or smoke,
• how surgical wounds and pain are treated after the surgery,
• what should happen if the operation leads to the discovery of a certain illness, such as cancer,
• whether medical or personal requests will be noted in your medical file,
• whether and how much medical information is allowed to be shared with family members and friends,
• whether you have, or have to make, arrangements for written documents like an advance health care directive or power of attorney,
• how soon after surgery you can return home, and how you will get there,
• when you can return to work,
• whether you will need help at home after the surgery, for instance with household chores or looking after children.

It can be helpful to write down any questions you have before you talk with the doctor, and take the list along to the appointment.

When you face surgery, you might have many concerns. One common worry is about going under anesthesia. Will you lose consciousness? How will you feel afterward? Is it safe?

Every day about 60,000 people nationwide have surgery under general anesthesia. It’s a combination of drugs that’s made surgery more bearable for patients and doctors alike. General anesthesia dampens pain, knocks you unconscious and keeps you from moving during the operation.

“Prior to general anesthesia, the best ideas for killing pain during surgery were biting on a stick or taking a swig of whiskey,” says Dr. Emery Brown, an anesthesiologist at Massachusetts General Hospital in Boston. Things improved more than 150 years ago, when a dentist in Massachusetts publicly demonstrated that the anesthetic drug ether could block pain during surgery. Within just a few months, anesthesia was being used in Australia, Europe and then around the world.

“General anesthesia changed medicine practically overnight,” says Brown. Life-saving procedures like open-heart surgery, brain surgery or organ transplantation would be impossible without general anesthesia.

General anesthesia affects your entire body. Other types of anesthesia affect specific regions. Local anesthesia—such as a shot of novocaine from the dentist—numbs only a small part of your body for a short period of time. Regional anesthesia numbs a larger area—such as everything below the waist—for a few hours. Most people are awake during operations with local or regional anesthesia. But general anesthesia is used for major surgery and when it’s important that you be unconscious during a procedure.

General anesthesia has 3 main stages: going under (induction), staying under (maintenance) and recovery (emergence). NIH-funded scientists are working to improve the safety and effectiveness of all 3.

The drugs that help you go under are either breathed in as a gas or delivered directly into your bloodstream. Most of these drugs act quickly and disappear rapidly from your system, so they need to be given throughout the surgery. A specially trained anesthesiologist or nurse anesthetist gives you the proper doses and continuously monitors your vital signs—such as heart rate, body temperature, blood pressure and breathing.

“When patients are going under, they experience a series of deficits,” says Dr. Howard Nash, a scientist at NIH’s National Institute of Mental Health. “The first is an inability to remember things. A patient may be able to repeat words you say, but can’t recall them after waking up.”

Next, patients lose the ability to respond. “They won’t squeeze your fingers or give their name when asked,” Nash says. “Finally they go into deep sedation.”

Although doctors often say that you’ll be asleep during surgery, research has shown that going under anesthesia is nothing like sleep. “Even in the deepest stages of sleep, with prodding and poking we can wake you up,” says Brown. “But that’s not the case with general anesthesia. General anesthesia looks more like a coma—a reversible coma.” You lose awareness and the ability to feel pain, form memories and move.

Once you’ve become unconscious, the anesthesiologist uses monitors and medications to keep you that way. In rare cases, though, something can go wrong. About once in every 1,000 to 2,000 surgeries, patients may gain some awareness when they should be unconscious. They may hear the doctors talking and remember it afterward. Worse yet, they may feel pain but be unable to move or tell the doctors.

“It’s a real problem, although it’s quite rare,” says Dr. Alex Evers, an anesthesiologist at Washington University in St. Louis. “Anesthesia awareness can lead to post-traumatic stress disorder,” a severe anxiety disorder that can arise after a terrifying ordeal.

Scientists have developed strategies to identify and prevent anesthesia awareness. Small studies suggested that brain monitors might help. But in 2008, Evers and his colleagues reported the results of the largest study to compare different techniques. Brain monitoring did no better than standard monitoring in preventing anesthesia awareness.

Addiction to alcohol or drugs increases the risk for anesthesia awareness, but doctors can’t accurately predict who will be affected. A research team in Canada identified variations in a gene A stretch of DNA, a substance you inherit from your parents, that defines characteristics such as eye color, your risk for disease and your likely response to different medications. that may allow animals to form memories while under anesthesia. Ongoing studies are exploring whether this gene plays a role in anesthesia awareness in people.

Other researchers are searching for genes that may affect how anesthetic drugs are processed, or metabolized, by the body. Genetic differences might affect the proper dosage or the selection of drugs for each patient.

Nash and his colleagues have found that studies of the common fruit fly may offer clues to how genes affect anesthesia. When certain repeating segments—called copy number variations—are snipped from the fly’s genome, it affects the insect’s response to anesthesia. Copy number variations are known to affect human responses to other drugs. Nash suspects that these gene segments may also affect how patients react to anesthesia. “As researchers learn more, I expect genetic screening will become more common in the clinic,” says Nash.

After surgery, when anesthesia wears off, you may feel some pain and discomfort. How quickly you recover will depend on the medications you received and other factors like your age. About 40% of elderly patients and up to one-third of children have lingering confusion and thinking problems for several days after surgery and anesthesia.

Right now, the best cure for these side effects is time. Brown and his colleagues are working to develop drugs to help patients more quickly emerge and recover from general anesthesia.

Anesthesia is generally considered quite safe for most patients. “Anesthetics have gotten much safer over the years in terms of the things we’re most worried about, like the patient dying or having dangerously low blood pressure,” Evers says. By some estimates, the death rate from general anesthesia is about 1 in 250,000 patients. Side effects have become less common and are usually not as serious as they once were.

Don’t delay important surgery because of fear of anesthesia. If you have concerns, talk with your doctor. It might help to meet in advance with the person who will give you anesthesia. Ask what kind of anesthesia you will have. Ask about possible risks and side effects. Knowing more might help you feel less concerned about going under.

When You Go Under

General anesthesia has 5 major effects on your body. Researchers are working to develop drugs that target each of these characteristics:

• Lack of Consciousness. Keeps you from being aware of your surroundings.
• Analgesia. Blocks your ability to feel pain.
• Amnesia. Prevents formation of memories.
• Loss of Movement. Relaxes your muscles and keeps you still during surgery.
• Stable Body Functions. Stabilizes your heart rate, blood pressure, temperature, breathing and kidney function.

It is totally normal to feel anxious before surgery. Even if operations can restore your health or even save lives, most people feel uncomfortable about “going under the knife.” It is important to make sure that fears and anxiety don't become too overwhelming.

There are many things that can help people better cope with anxiety before surgery: Many hospitals offer special support, and family and friends can help too. Although there is not yet much research on strategies for managing pre-surgery anxiety, some evidence suggests that certain measures such as music and sedatives can help.

What are the possible effects of anxiety?

It is very normal to feel anxious before having an operation, especially the day or two beforehand, which are often spent in the hospital preparing for the operation. Sometimes people have day surgery, where they go to the hospital or practice, have the procedure and then go home on the same day. But even then it can be hard not to worry about the operation, the possible risks and the anesthetic beforehand.

Severe anxiety can cause unpleasant symptoms and stress. Typical symptoms include a pounding heart, a racing heart (fast pulse), irregular heartbeat, nausea, a nervous stomach, shortness of breath and sleep problems. These anxiety-related symptoms can be particularly worrying for people who have pain due to a heart condition. Anxiety can make pain worse, as well as making it harder to cope with the pain. But the physical signs of anxiety are usually not a sign that a heart condition is getting worse.

Anxiety also becomes a problem if it makes it harder to understand and remember important things you are told about the operation, such as advice about how to prepare for it or about recovering afterwards.

What can help relieve anxiety before surgery?

The first thing you can do to reduce anxiety is learn to understand how it affects you. Anxiety is a very strong feeling. One of its functions is to protect us from danger. So anxiety may stop you from getting into dangerous situations in the first place. It also prepares your body so you can defend yourself or quickly escape from the danger – a reaction also known as the “fight-or-flight response.” That's why anxiety increases your heart rate, increases your blood pressure and keeps you awake. But if there is no real danger, this response isn't helpful and can have negative consequences.

Over time, most people learn how to manage their own anxiety and handle frightening situations. They develop suitable strategies to cope with what is causing the anxiety. But going into the hospital and having an operation is often a completely new situation. Here they often need emotional and practical support from friends and family too.

People might cope with pre-surgery anxiety in very different ways: Some try to prevent anxiety or stress by getting information early on and talking with other people about their concerns. Others distract themselves by reading, or use exercise or relaxation techniques like slow and deep breathing. Several studies have suggested that listening to music before surgery can relieve anxiety. Music can help you relax and distract you. Different people will find different types of music helpful, depending on their personal taste in music.

How can doctors and other medical professionals help?

There are some things that patients should be able to take for granted in a hospital: For example, that the staff understand the needs of the patients, waiting times are kept as short as possible, and the hospital stay is made as pleasant as possible.

Most hospitals provide contact with counselors, social workers or volunteers who offer support and assistance. The most suitable type of professional support will depend on what is causing the anxiety. For example, someone who is afraid of having an anesthetic will need a different type of support than someone who is mostly anxious about being in a hospital.

Relaxation techniques such as breathing exercises, meditation or muscle relaxation can be helpful. These techniques can be learned in classes or with the help of pre-recorded audio training courses.

Massages, acupuncture, homeopathy, aromatherapy or hypnosis are sometimes offered before surgery too. But they haven't been scientifically proven to help relieve anxiety before surgery.

Do sedatives help relieve anxiety before surgery?

People who are already in hospital the night before an operation are usually given medicine to help them sleep or a sedative to reduce anxiety. Benzodiazepines are often used for this purpose. These drugs reduce anxiety, help you to relax, and make you sleepy at the same time. They might also make you feel drowsy or nauseous. The sleep hormone melatonin is used in some hospitals. But this medication has only been approved for use in people who are 55 and older. The possible side effects include headaches and stomach pain.

Sedatives are also given before the operation, usually in the last two hours before the anesthetic is given.

It is important to tell your doctor if you already took a sedative before arriving at the hospital.

What if you smoke cigarettes?

Many people who smoke tend to smoke even more when they’re feeling anxious. Even if that calms their nerves in the short term, smoking increases the risk of complications after surgery – particularly related to the wound-healing process. Starting nicotine replacement therapy one to two months before surgery can reduce the risk of complications.

Protect yourself and your loved ones from infections related to surgery. Having any type of surgery can be stressful. You might be asking yourself: What is the recovery process? How long will I be out of work? What do I do after leaving the hospital or surgery center?

An important question you might not have thought of is: How do I avoid getting a surgical site infection (SSI)?

A SSI is an infection patients can get during or after surgery. SSIs can happen on any part of the body where surgery takes place and can sometimes involve only the skin. Other SSIs are more serious and can involve tissues under the skin, organs, or implanted material.

These infections can make recovery from surgery more difficult because they can cause additional complications, stress, and medical cost. It is important that healthcare providers, patients and loved ones work together to prevent these infections.

What can healthcare providers do to ensure that the surgical site is clean?

• Clean their hands and arms up to the elbows with an antiseptic agent just before the surgery.
• Wear hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
• Give you antibiotics before surgery starts when indicated.
• Clean the skin at the surgery site with a special soap that kills germs.

How can you and your loved ones prevent surgical site infections?

• Before your surgery, discuss other health problems, such as diabetes, with your doctor. These issues can affect your surgery and your treatment.
• Quit smoking. Patients who smoke get more infections.
• Follow your doctor’s instructions for cleaning your skin before your surgery. For example, if your doctor recommends using a special soap before surgery, make sure you do so.
• Avoid shaving near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection. If someone tries to shave you before surgery, ask why this is necessary.

After surgery, be sure to follow the recommendations below to protect against surgical site infection.

• Ask your provider to clean their hands before they examine you or check your wound.
• Do not allow visitors to touch the surgical wound or dressings.
• Ask family and friends to clean their hands before and after visiting you.
• Make sure you understand how to care for your wound before you leave the medical facility.
• Always clean your hands before and after caring for your wound.
• Make sure you know who to contact if you have questions or problems after you get home.
• If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately.

If you need surgery, you may have a lot of questions. Select the questions you want to remember to ask.

• Why do I need surgery?
• Is there some other way to treat my condition?
• What kind of surgery do I need?
• Have you done this surgery before?
• Which hospital is best for this surgery?
• Will I need anesthesia?
• How long will it take me to recover?
• How long will I be in the hospital?
• What will happen after the surgery?
• What will happen if I wait or don't have this surgery?