When other methods are useless
It is impossible to determine at what stage during the evolution of the human species the art of surgery first emerged. Most probably it was when a clever and daring healer realized that "what cannot be healed by medicine can be healed by the scalpel." Numerous findings, both prehistoric and later, suggest the application of surgical techniques for the treatment of various ailments.
The development of general anaesthesia opened up the horizons for surgery. With the patient asleep on the surgical table and with the abdomen "opened up", the surgeon was given the opportunity to access every space and organ in the peritoneal cavity. The 19th century witnessed the great moments of general surgery. The giants of surgery dared and where successful in curing serious illnesses of the time using daring surgical procedures which have gone down in history bearing their names.
Although in my everyday professional practice I choose to apply laparoscopic or robotic surgery, open surgery still remains a powerful tool in my hands. I opt for it in emergency situations where, for a problem to be solved there is a requirement for speed, wide surgical exposure, and broad surgical manipulations, for example in cases of severe bleeding, severe septic peritonitis, or for extensive abdominal trauma. An open surgical field is also required in cases of large neoplastic tumours, as they must be removed intact, inevitably necessitating a large incision.