"A bad worker blames his tools," says an old proverb. This may be true, but a good surgeon needs his tools to be sharp, safe, and effective. Have you ever wondered how these important tools for surgery came to be?

The History of Surgical Tools

It may come as a surprise, but there are signs that surgeons evolved earlier than was thought before. Skeletons from 6500 BC that were found in France show signs of trepanning. Even Egyptian skeletons show signs of having surgery (and lived for a while after that!)

Later, the ancient Greeks set broken bones, cut off hurt limbs, and drew blood from boils with lancets and hot cups. The Romans used tools to get rid of goitres and polyps, too. By the Middle Ages, barber-surgeons could fix problems like cataracts and bladder stones. But because they didn't know about sepsis yet, most people who got sick died from infections.

For these jobs, early "surgeons" had to use tools. They used what they had on hand because they didn't have stainless steel or autoclaves. The first doctors used their teeth, fingers, and fingernails to treat their patients. Later, they used flint, other sharp stones, and iron and steel. But you might be surprised to learn that early surgeons used their fingers and teeth to do their work. This led to the development of more advanced tools that are still used today.

• Tools like surgical scissors now do the work that fingernails and teeth used to do.

• Clamps and holders took the place of pinching and grabbing with the fingers and thumb or squeezing with the teeth.

• Tools that pulled and opened up incisions and wounds took the place of the fingers.

• Now, instead of fingers and teeth, staples and sutures are used to hold cut edges of tissue together.

• Sucking and sucking-up tools were used instead of the mouth to get fluid out.

New tools for surgery

In the late 1800s and early 1900s, there was a big change in how surgical tools were made. Before, the abdomen, the chest, and the head were off-limits, and for a good reason. But when surgeons learned about anaesthesia and asepsis, they could relax and work on the most important parts of the body. When surgeons had to work on new parts of the body, they had to get new tools and learn how to use the ones they already had better. Surgical scissors, surgical forceps, surgical tweezers, and surgical scalpels were better so they could be used more carefully in the brain, the abdomen, and the inside of the thoracic cavity.

In the 1920s, another big change emerged when surgical scalpels with single-use blades emerged. They quickly became the most popular way to keep knives sharp and lower the risk of getting sick. Around the middle of the 20th century, new materials were found that could be used to make surgical tools. Steel was still the most popular material for surgical tools, but chrome, titanium, and vanadium became popular for making lightweight, durable, precise surgical instruments. Microsurgical procedures in ophthalmology, neurology, and otology became possible when titanium alloys were used to make small but strong surgical tools.

The newest improvements in surgical tools

Some of the most important changes to surgical tools came at the end of the 20th century. First came electronic surgical tools, such as endoscopic and laparoscopic, electrocauteries, ultrasound, electric surgical scalpels, arthroscopic shavers, and other powered surgical instruments. Next, doctors saw how powerful it could be to use computers in surgery. Heart surgery, neurology, urology, gynaecology, and thoracic surgery are all becoming more likely to use computer-guided endoscopic surgery. When computers are linked to specially made surgical instruments, the surgeon can work in a small space and do things that can't be done with the human hand alone.

What's next for surgical tools?

It's hard to tell what will happen in the future, but many people think robots will take over operating rooms. Robot-assisted surgery is becoming increasingly common in the US, and surgeons are still finding out how useful it can be.

Even though teeth and nails were used by "surgeons" in the past, a robotic-assisted surgical scalpel is still based on what they did. Even though robots are improving surgical tools, they still owe a lot to the first people who used them.