The evolution of pediatric surgery


Nearly 100 years ago, William Ladd, MD, of Boston Children’s Hospital, helped establish pediatric surgery as a medical subspecialty. The recognition that children require unique surgical management hasn’t changed, but the instruments and procedures we use to operate on children have evolved dramatically. Here’s a glimpse of the surgical state of the art then and now.


The 1920s marked the earliest use of scrub attire. White gowns, white masks and white linens emphasized the importance of cleanliness — and perhaps compensated for the dim lighting. Chloroform and ether, dating back before the Civil War, were the anesthetics of the day. Though penicillin was discovered in 1928, antibiotics were still two decades away from actual use. Imaging was limited to X-rays. It was in this setting that pediatric surgery began to evolve.


Today’s operations are increasingly more precise and less invasive. Surgeons can practice on custom 3-D models of patients’ anatomy, take an MRI scan mid-operation to ensure accuracy and (at least in animals) repair a still-beating heart with a patch delivered through a vein. “GPS” systems are guiding surgeons to deep lesions through the smallest possible incisions, lasers are replacing scalpels and robots are handling complex moves. Above, surgeons operate on a child with spasticity, opening a small window in his spine and carefully stimulating each nerve before deciding which to cut.

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