Surgical training in Sushrut period

1. WELCOME

3. rÉÉåarÉÉxÉÔ§ÉÏrÉ

4. Introduction
Acharya sushruta explained about yogyasutreeya in sutrastana,
prior to that initial chapters of sutrastana he talks on ayurveda
utpatti, shalyatantra pradhanyata, guru, shishya, adhyayana
kaala. In later chapter about sushruta samhita in nut shell.
Then in AaÉëÉåmÉUhÉårÉ aboutmÉÔuÉï, mÉëkÉÉlÉMüqÉï and mɶÉÉiÉMüqÉï,
qualities of surgeon. In the 6th chapter he elaborately explains
about GiÉÑcÉrÉÉï, in 7th chapter rÉl§É , zÉx§É their qualities and uses.
I think the Idea of Sushruta behind this type of frame work of
chapter is, first made student aware about what he is going to
learn in future like in AaÉëÉåmÉUhÉÏrÉ AkrÉÉrÉ ,where in context of
mÉëkÉÉlÉMüqÉï he says one should avoid incisions over qÉqÉïxjÉÉlÉ,
but about qÉqÉï he talks in detail in shareera sthana .

5. rÉÉåarÉ:
MüiÉïurÉMüqÉïhÉÈxÉqrÉarÉÉåaÉÉrÉ iÉixÉSèzÉMüqÉÉïprÉxÉÉå
rÉÉåaÉÈ iÉålÉ rÉÉåaÉÉrÉmÉëpÉuÉiÉÏÌiÉ||
cÉ¢ü xÉÑ xÉÔ9/3
Before operating on patient directly one should practice
surgical procedure on models which are similar to the
human body structure.

6. ELIGIBILITY FOR rÉÉåarÉÉ:
AÍkÉaÉiÉxÉuÉïzÉÉx§ÉÉjÉïqÉÌmÉÍzÉwrÉÇ rÉÉåarÉÉÇMüÉUrÉåiÉç|
xlÉåWûÉÌSwÉÑNåûkrÉÉÌSwÉÑcÉ MüqÉïmÉjÉqÉÑmÉÌSzÉåiÉç|
xÉÑoÉWÒû´ÉÑiÉÉåÅmrÉM×üiÉrÉÉåarÉÈ MüqÉïxuÉrÉÉåarÉÉå
pÉuÉÌiÉ||xÉÑ.xÉÔ.9/3
The student though has understood the science fully should
be made a fit for advising treatment, he should be instructed
the practical methods of xlÉåWûÉÌS mÉlcÉMüqÉï NåûSlÉÉÌS
A¹ÌuÉkzÉx§ÉMüqÉï. Though a person having well theoretical
knowledge if he does not do rÉÉåarÉÉprÉÉxÉ he is unfit for
medical practice.

7. NåûSlÉrÉÉåarÉÈ(Excision)
iɧÉ,mÉÑwmÉTüsÉÉsÉÉoÉÔMüÉÍsÉlSMü§ÉmÉÑxÉæuÉÉï
ÂMüMüMüÉïÂMü
mÉëpÉ×ÌiÉwÉÑNåûkrÉÌuÉzÉåwÉÉlÉçSzÉïrÉåiÉç,
EiMüiÉïlÉÉmÉMüiÉïlÉÉÌlÉ
cÉÉåmÉÌSzÉåiÉç;
Aim: To know application of force to excise different
types of tissue with different surfaces and resistances.
Model: pushpa phala, alabu, kalindaka, trapusa,
kushmanda, Ervaruka, karkaruka,

8. pÉåSlÉrÉÉåarÉÈ (Incision)
SØÌiÉoÉÎxiÉmÉëxÉåuÉMümÉëpÉ×ÌiÉwÉÔSMümɃ¡ûmÉÑhÉåï
wÉÑpÉå±rÉÉåarÉÉÇ;Aim: To know about the thickness of the wall which is to
be penetrated.
Consistency of the fluid inside.
Model: water filled leather bag and bladder of the animals
filled with mud or materials of various consistencies.

9. sÉåZÉlÉrÉÉåarÉÈ (Scraping)
xÉUÉåÎqhÉ cÉqÉïhrÉÉiÉiÉå sÉåZrÉxrÉ;
Aim: To scrape the area with delicate balance of knife
avoiding injury to underlying structures.
Model: Dead animal skin with hair or animal skin
with warty transformations as seen over joints.

10. uÉåkrÉrÉÉåarÉÈ (Puncturing)
qÉ×iÉmÉzÉÑÍxÉUxÉÔimÉsÉlÉÉsÉåwÉÑcÉ uÉåkrÉxrÉ;
Aim: To penetrate into vessel, gaining dexterity to
enter the vessels with precision and accuracy.
Model: Vessels of dead animal, lotus stem.

11. LwÉhÉrÉÉåarÉÈ(Probing)
bÉÑhÉÉåmÉWûiÉMüɹuÉåhÉÑlÉsÉlÉÉsÉÏzÉÑwMüÉsÉoÉ
ÔqÉÑZÉåwuÉåwrÉxrÉ;
Aim: To trace the path with least resistance.
Model: On worm eaten hollow pieces of dry wood,
Bamboo stem, Dried Alabu.

12. AÉWûUhÉrÉÉåarÉÈ (Extraction)
mÉlÉxÉÌoÉqoÉÏÌoÉsuÉTüsÉqÉ‹qÉ×iÉmÉzÉÑSliÉåwuÉÉWûÉ
rÉïxrÉ;
Aim: Go to the base or behind the object and pull out.
To appreciate the optimum grip and force and to remove
the foreign body causing least damage to the
surrounding structures.
Model: bimbi, bilva, Jack fruit, teeth of the dead
animals.

13. ÌuÉxÉëÉuÉhÉrÉÉåarÉÈ(Dainage)
qÉkÉÑÎcNû¹ÉåmÉÍsÉmiÉåzÉsqÉsÉÏTüsÉMåü
ÌuÉxÉëÉurÉxrÉ;
Aim: To make superficial incision not to going beyond
skin.
Model: surface of shalmali coated with bee wax.

14. xÉÏuÉlÉrÉÉåarÉÈ (Suturing)
xÉÔ¤qÉbÉlÉuÉx§ÉÉliÉrÉÉåqÉ×SÒcÉqÉÉïliÉrÉÉå¶É xÉÏurÉxrÉ;
Model: thin - thick cloth or leather,
thin - thin cloth or leather,
thick - thick cloth or leather.
Aim: Approximation of edges and suturing the wound.

15. oÉlkÉlÉrÉÉåarÉÈ (Bandaging)
mÉÑxiÉqÉrÉmÉÑÂwÉÉ…¡ûmÉëirÉ…¡ûÌuÉzÉåwÉåwÉÑ
oÉlkÉlÉrÉÉåarÉÉÇ;
Aim: 14 types of bandaging to suit the wounds at
different locations of the body.
Model: Tying bandages round the specific limbs
and parts of dummies.

16. AÎalɤÉÉUrÉÉåarÉÈ
qÉ×SÒwÉÑ qÉÉÇxÉZÉhQåûwuÉÎalɤÉÉUrÉÉåarÉÉÇ,
Aim: Application of pratisaraniya kshara and different
types of agni karma
To Appreciate kshara and agni dagdha lakshanas.
Model : flesh of animals.

17. MühÉïxÉÎlkÉoÉlkÉlÉrÉÉåarÉÈ
qÉ×SÒcÉqÉïqÉÉÇxÉmÉåzÉÏwÉÔimÉsÉlÉÉsÉåwÉÑcÉ
MühÉïxÉÎlkÉoÉlkÉlÉrÉÉåarÉÉÇ
Aim: Reconstruction of tissue
Model : On skin,
soft muscle or flesh,
stem of lotus lily.

18. mÉÏQûlÉrÉÉåarÉÈ
ESMümÉÔhÉïbÉOûmÉɵÉÉïxÉëÉåiÉxrÉÉsÉÉoÉÔqÉÑZÉÉÌS
wÉÑ cÉ
lÉå§ÉmÉëÍhÉkÉÉlÉoÉÎxiÉuÉëhÉoÉÎxiÉmÉÏQûlÉrÉÉåarÉÉÍqÉÌiÉ||
xÉÑ.xÉÔ.9/4
Aim : Proper insertion of bastinetra into the opening.
Maintain same pressure throughout the process
of basti pranidhana.
Model: Pitcher containing water with lateral opening,
Alabu.

20. CURRENT DAY PRACTICE:
SIMULATION:
It is process of designing a model of a real system and
conducting experiments with this model for the purpose
either of understanding the behavior of system or of
evaluating various strategies for the operation of system.
CLASSIFICATION OF SIMULATIONS
►Model-based simulation
►Computer-based simulation
►Hybrid simulation

21. MODEL-BASED SIMULATION:
MODEL:
A three-dimensional representation of a person or thing or of a
proposed structure, typically on a smaller scale than the original.
This is mainly based on physical models. Procedures
commonly include wound closure urinary catheterization,
Vene puncture and I.V. infusion.

22. COMPUTER-BASED SIMULATION:
Computer simulations are more realistic simulations in
which computers create illusions of reality (VR).
VR combines a convincing representation of an organ
system or body region with the means to work with
that image as if it really existed.

23. HYBRID SIMULATION:
Hybrid simulators combine physical models with
computers, using a realistic interface. This avoids some of
the technical difficulties associated with reproducing the
feel of instruments and human tissue.

24. BENEFITS OF rÉÉåarÉÉ:
LuÉqÉÉÌSwÉÑqÉåkÉÉuÉÏrÉÉåarÉÉWåïûwÉÑrÉjÉÉÌuÉÍkÉ|
SìurÉåwÉÑrÉÉåarÉÉÇMÑüuÉÉïhÉÉå lÉ mÉëqÉѽÌiÉ MüqÉïxÉÑ||
iÉxqÉÉiÉçMüÉæzÉsÉqÉÎluÉcNûlÉçzÉx§É¤ÉÉUÉÎalÉMüqÉïxÉÑ|
rÉxrÉ rɧÉåWûxÉÉkÉqrÉïÇiÉ§É rÉÉåarÉÉÇxÉÉqÉcÉUåiÉç||xÉÑ.xÉÔ.9/5-6
The student who has been made fit by the use of the
things which are suitable for practical training, does not
get confuse in the profession.
Hence, students who desire to expert in zÉx§É¤ÉÉUÉÎalÉMüqÉï
should do practical work on similar models.

25. CONCLUSION:
Sushruta’s method of training and practice of
surgery acceptable till date.
Sushruta designed experimental surgery to arouse
active interest in the subject and to give a permanent
mental impression of the basic surgical procedures.
Sushrutas concept still remains valid ,application
may differ.