title: The quincunx of surgery.
abstract: From the earliest days of surgery the central and unifying theme of the discipline has been the mastery of technical proficiency with the view to not only management of the diseased or damaged part but the preservation of general health and well being. This central tenet of the discipline has been supported by four critical columns of knowledge, each of which has amplified over the passage of time. Initially anatomy was the cornerstone of surgical intervention and mastery of surgery to a large part depended upon a secure grasp of the intricacies and relationships of corporeal macro structure. The second column comprised functional anatomy or physiology and the appreciation of organ activity enabled the subsequent delineation of malfunction during disease. Regardless of the level of sophistication that could be brought to bear upon the disease a requisite for most successful technical intervention was the management of pain and the prevention of sepsis. As the quincunx of surgery embraces a new century it must continue to evolve to maintain the balance of growth in the four supporting columns. Thus anatomy has been expanded into subcellular structure and the elucidation of function has amplified into the role of individual organelles. Similarly pathology has moved beyond the organ and cell into the genome and deletion may be conceived of in terms of codons and sequences rather than colons and spleens. Indeed it is feasible that antisense strategies may become more sensible than antibiotics. Manual and digital techniques will be supplanted by robotic intervention and visualization will move beyond the visible into the non-visible world of spectroscopy. Millimetric dexterity will need to become nanometric and the mantra must become molecular and intervention directed not only at adults or neonates but the fetus. In order to achieve such goals teaching and training strategies need dramatic revision to produce individuals capable of transforming from tactile to telemetric skills and from gentle technique to genomic intervention.
authors.affiliation: Yale University, USA.
authors.forename: I M
authors.initials: IM
authors.lastname: Modlin
mesh_terms: D000328:Adult; D013502:General Surgery / Q000639:trends*; D006801:Humans; D007231:Infant, Newborn