Interconnecting surgical science, art, philosophy and technology for holistic health

Abstract

Surgery is the branch of medicine which involves correction of the diseases by means of interventions and by means of various instruments and methods. Surgery in latin is called as Chirugi and in the Indian context it is termed as ‘Shalyatantra’. Surgery is the science as well as the tantra or technology. Ayurveda itself believes that, it is the technology by applying the word tantra to it. Shalyatantra is not only the technology, but it is the science with firm foundations; and the procedures or interventions involve the art within it. The philosophical insights from various Darshanas contributed to the derivation of foundational principles. The expert of surgery is called as ‘Surgeon’ and termed as ‘Shalyatantragya’ by Ayurveda. A surgeon has to master not only the science and art of surgical procedure; but also the philosophy, technology alongwith the details of medicines and drugs formulations. The procedures in surgery are the techniques, which have to be mastered by means of practice and by performing multiple operations. But this is not enough to become a good surgeon. The essential conditions for the expertise in surgery are, to master upon the surgical science and philosophy and to get acquainted with the advanced technologies also. In this particular article, the interconnections among surgical science, art, philosophy and technology and their applications are being discussed with special emphasis upon the ancient text of Sushruta, that is, Sushruta Samhita. Also it has been tried to critically analyse how the guiding principles from ancient Shalyatantra of Sushruta can be contributory to the surgery of the current medical practice.

1. Meaning of holism

The meaning of the word Holism as per Oxford Dictionary is, the whole is more than sum of its parts [1].

The word was coined by Jan Smuts in his famous book ‘Holism and Evolution’. It represents the interconnection between whole and parts. As per Smuts, “holism is the ultimate synthetic, ordering, organizing, regulative activity in the universe which accounts for all the structural groupings and syntheses in it.” [2] The important characteristic is the non seperability. This non seperability has to be understood in the physical as well as biological dimensions. The concept has been adopted by the medicine and healthcare sector. In recent times the medical fraternity has started realizing that, the mainstream reductionist medicine is not sufficient to address and solve important challenges of the healthcare sector, which can be approached by means of the complementary and alternative system of medicine. In an essay by James Gorden, Holistic medicine: Advances and Shortcomings;

“Holistic medicine is an attitudinal approach to healthcare rather than a particular set of techniques. It addresses the psychological, familial, societal, ethical and spiritual as well as biological dimensions of health and illness. The holistic approach emphasizes the uniqueness of each patient, the mutuality of the doctor-patient relationship, each person’s responsibility for his or her own health care and society’s responsibility for the promotion of health.” [3]

Rather than only focusing upon the mechanistic and reductionist approach to any disease, this approach emphasizes upon psychological, familial, societal, ethical and spiritual dimensions so as to give best possible results to the patient.

2. Ayurveda and holistic health

The approach of holistic medicine is not a new one. This approach is fundamentally seen in Ayurveda and the ancient classics of Ayurveda especially Charaka Samhita, Sushruta Samhita, Vagbhata Samhita. In these texts, the entire approach is such that which currently we call holistic. Ayurveda, as the science, approaches each patient in person by defining the Prakriti, Tridosha, Agni, Dhatu, Mala and multiple other factors which need to be interpreted by holistic view. The process of diagnosis involves multiple interconnections, networks, interrelations, interactions and levels of organisation which need to be understood carefully by any physician. As like the systems view proposed by the systems biology, Ayurveda also takes into consideration the systems view and accordingly designs the treatment.

3. Shalyatantra

Ayurveda is divided into eight main branches for the ease of study and Shalyatantra is one among them. This branch mainly deals with the diseases which can be managed by interventions or surgical means. The text which has been dedicated for Shalyatantra is Sushruta Samhita composed by the sage Sushruta [4]. This ancient text is supposed to be the foundational text for the science of surgery in Ayurveda. The experts of medicine in ancient times used to recommend the expertise of surgeon, so as to correct any surgical condition requiring intervention. But this text is not limited to only descriptions of surgical procedures, but it describes various aspects of basic principles, anatomical details, physiological understanding, diagnostic principles, dietary principles, toxicology, pharmacology, medicinal treatments, gynecological diseases and treatment, ear-nose-throat- eye diseases and treatment, orthopedics, urology, instruments and much other information required for a surgical student to be an efficient surgeon. Shalyatantra, as a subject is broad one and needs thorough study of all other branches also, to be expert in the field. But alongwith these, what additionally required for a surgeon is, to explore the interconnection required for surgical science, art, philosophy and technology to get effective results for the patients and for holistic health.

4. Surgical science as well as surgical art

Surgery is the branch of medicine which is designed mainly to cure diseases by means of invasions or interventional techniques. These techniques and procedures have been evolved over the long period by the generation of surgeons. Last 200 years have shown major revolutions in modern surgery. Before one hundred seventy eight years, that is, before the discovery of anesthesia in 1846, surgery was quite painful and crude with very high mortality and morbidity. But after anesthesia, the surgical discipline got revolutionized as it became easier for the surgeons to do experiments and find newer techniques. In the post-anesthesia discovery era, not only limited to newer techniques, but also the advances like antibiotics, antisepsis have contributed to surgery and reduced mortality substantially. The progress of surgical discipline was like the progress of any other scientific branch like by means of observation, experimentation, applications etc. [5] Surgery is the science and involves the artistic components also within it. It is not completely subjective endeavor as like the artist, but it is the science with defined aim, objectives and methods to give the best outcome to the patient. But along with the scientific rigor, it needs the artistic mindset and skills for the surgeon to get best surgical results.

Shalyatantra or Surgery which includes surgical training has to be very rigorous. A surgeon has to deal with the disease conditions which are risky and difficult to treat. The major factor in any surgical treatment is ‘intervention’ to the body and its structure. Whenever there is any intervention, it is with the risks as well as benefits. Nobody will like to get operated on him or her by any inefficient surgeon. In the quotation of Sushruta Samhita Sutrasthana Chapter 3, 48–50; Sushruta mentions that, a person (studying medicine) who is inefficient in the practical study, gets fear of examining the patient, as like any coward person behaves in war; and a person who has been expert with practical study, but has not done proper theoretical study, does not deserve respect in the community of scholarly people and also gets punishment from king. A person not knowing both is like the bird without wings [6]. Sushruta mentions about the qualities of a surgeon, where he explains that, a surgeon should have courage, his actions should be deliberate, quick and disciplined, the instruments must be sharp and properly functioning, he should not have much sweating, he should not get tremors and his handling should be stable, he should not get any syncopal attacks because of fear or disease (Sushruta Samhita Sootrasthana 5/10). Further Sushruta describes the importance of Yogya in Sushruta Samhita chapter 9, where Sushruta mentions the methods for studying the techniques of surgery for the students, for acquiring as well as enhancing the surgical skills. It is nothing but practicing on the models. It is exactly similar like the simulations available in current surgical training. In that period, it has been advised to perform Yogya on the objects available in nature like fruits, vegetables, dead animal, plants etc.(Sushruta Samhita Sootrasthana 9/3-6). The purpose of Yogya is to make the mind and body of the surgeon efficient and compatible for surgical procedure. Surgery requires use of hands. The requirements for effective surgical maneuver can be explained as;

• •To have stable hands
• •To get ergonomically well positioning
• •To have effective hand eye coordination
• •To perform minimum, purposeful and deliberate movements
• •To assess the required force for intervention
• •To assess the stiffness and solidity of tissues with the force required for effective action
• •To get accustomed to the instruments and their handling techniques
• •To upgrade the level of concentration for surgical psyche
• •To increase the efficiency of surgeon for the physical stress involved in procedure.

It is important for a surgeon to have the effective and errorless action at the surgical field. The concept of ‘redoing’ because of errors is never acceptable in surgery. The concept of ‘Redoing surgery’ is there, but it has a different context of inherent complication of diseases and not because of errors. Hence to have such errorless, precise, perfect surgical act and procedure; there is a need of practice. Even as mentioned above, the physical stress for surgeon and efficiency are interrelated. If surgeon is not physically fit, he or she can not perform long standing and extensive procedures like cancer surgery, laparoscopic surgery. For example, Laparoscopic surgery has the positioning and the instrumental arrangements in such a way that, it causes physical stress to surgeon's back, shoulders, eyes etc. So as to acclimatize to this, a surgeon has to properly use the simulations for laparoscopic surgeries. Hand eye coordination is also the key in laparoscopic surgery. To achieve this, surgeon has to practice effectively on simulations. Also surgery is the team work, hence the actions of other team members need to be trained and the members should acclimatize to each other. Surgical steps must be known to all team members, which can prevent undue confusion at the operation table. The effective environment at the surgical operation theatre gives excellent outcomes for the patient, which includes hygiene, aseptic precautions, discipline, silence, dress code, good space for activity, stress free environment, limited but necessary dialogue, well design of work space, well trained staff etc. Good surgical teamwork is the key for success of operation and surgeon needs to have good managerial skills also for this.

The mindset of surgeon puts substantial impact on surgical decision making as well as surgical outcome. Major requirements for a surgeon is to have courage, have calm mind in difficult situations, capacity to tolerate the physical and mental stress, quick and immediate actions in emergency situations and patience as well. These qualities need to be developed over a period of time and also the inherent nature of surgeon also carries importance. Though some qualities need to be inborn; there is requirement of training for the surgeons or surgical students. Mindfulness is one such character required for a surgeon. ‘Mindfulness is inherently about making a conscious choice about how to respond to that which is taking place around us, even when it is beyond our control.’ [7] The mind has to be trained in such a way that it will sustain its focus. This is similar with the characteristic of mind Sattva as mentioned in classical texts of Ayurveda. A surgeon should be Sattvik and even the patient should also have optimum Sattva so that the results of the surgical procedure will be optimum. It is difficult to perform any procedure on a person who is very fearful and uncooperative.

Sushruta in Sushruta Samhita Sutrasthana 35/3 describes the necessary conditions for examination of the patient as follows.

• •Vyadhi: underlying disease and pathology
• •Rutu: season
• •Agni: digestive capacity of patient
• •Vaya: age
• •Deha: body configuration
• •Bala: strength
• •Satva: intellectual, emotional and spiritual strength
• •Satmya: conducive conditions
• •Prakruti: body constitution
• •Bheshaja: medicine
• •Desha: country or area to which patient belongs.

The approach put forth by Sushruta is characterized by an effective combination of science, art, philosophy and techniques which are important in surgical practice. The art involves good communication skills, effective interventional skills and decision making skills. The healthy and effective communication with patient with necessary counseling skills can give good results. Effective interventional skills can be acquired only by seeing and handling multiple numbers of patents and performing good number of procedures. Even the process of registration or medical license existed in the period of Sushruta also, because Samhita mentions about taking permission of king before going to start the practice (Sushruta Samhita Sootrasthana 10/3).

5. Surgical decision making

Decision making is the main skill a surgeon should have. The process of decision making has multiple contributory factors. Though it involves the detailed understanding of surgery as science and the philosophy behind it, but the component of art of decision making can not be neglected. This art is mainly the clinical art including patient examination, diagnosis and designing treatment plan. The examination includes the proper clinical examination, where Sushruta mentions the use of all sense organs as well as questioning. For appropriate diagnosis, the clinical examination of the patient needs to be done properly. Sushruta combines empiricist and rationalist approach to reach the diagnosis. The process of art of clinical examination involves.

• •Knowledge of anatomy, physiology and surface marking
• •Observational skills
• •Inferential skills
• •Questioning skills
• •Collection of data
• •Communication skills
• •Skills of interpretation
• •Good Analytical capacity
• •Auditory, tactile, olfactory sense data interpretation
• •Grouping and subgrouping the data
• •Proper use of gadgets like thermometer, torch, pulse oxymeter, cloth, tourniquet, stethoscope, sphygmomanometer, pen, bandages, hammer, various scopes etc.

There are certain special determinant factors which have to be taken into account while assessing the surgical condition. These are.

• •Anatomical defects
• •The symptom complex
• •Transmission of light and Sound through tissues
• •Temperature variations
• •Pressure gradients
• •Movement of fluid and gas in cavities
• •Membranous integrity
• •Overproduction and underproduction
• •Physical characteristics of swellings
• •Pressures inside and outside the cavities
• •Postural changes
• •Movement restrictions
• •System interactions
• •Distant effects
• •Intraluminal and extraluminal relationship
• •Intracompartmental and intercompartmental relationship etc. [8].

The importance of clinical examination apart from the laboratory diagnostic tests has been mentioned by H.S. Souttar. The excerpt is as below;

“ I ask my students to realize that diagnosis does not consist in the collection of laboratory reports, but in trying to see beneath the surface of both the patient and of his story; and when I go round the wards I try to impress upon them that somewhere beneath the surface, even in the most ordinary case, there may lie hidden undreamt of possibilities. It would undoubtedly be of great advantage to all of us if many of the artists of the present day would give up the use of materials altogether and would confine themselves to moral and spiritual experiences; but I trust that future generations of surgeons will realize the essentially artistic nature of their work, and will pursue their calling as one of the greatest of the arts. – I am, etc,” [9]

6. Surgical as well as Shalyatantra philosophy

Philosophy is the love of wisdom. Philosophy teaches us to go to the roots of any problem. Current physical and material sciences are originated from natural philosophy. There are certain works done by the scholars like Sir James Paget, Rene Leriche on philosophy of surgery; but the oldest reference goes back to Sushruta Samhita only. The treatise is quite rich in the aspects of philosophy of surgery The initial collection of chapters which known as Sutrasthana gives the principles, which are nothing but the philosophical approach towards surgery. The beauty of Sushruta Samhita is, it is the collection of logic, epistemology, metaphysics, ethics in relation to surgery. Sushruta emphasizes empiricism as well as he gives importance to rational outlook. The philosophy of surgery is not limited to ethics; but ethics is one of the parts of it, which emphasizes upon autonomy, beneficence, non maleficience, human rights and their role in surgeon patient relationship. Sushruta mentions in various chapters (Sushruta Samhita Sootrasthana 1-46) the philosophical perspectives like;

• •Samkhya metaphysics and Ayurveda:

Sushruta has accepted the idea of origin of life and universe mentioned by Samkhya philosophy. The trio of Satva, Raja and Tama; which are the properties of Prakruti, are also seen in human and mainly termed as Manas-Prakruti (Psychological properties). A surgeon has to take into account the psychological well being of the patient before taking any surgical decision. Panchamahabhuta as mentioned by Samkhya are major philosophical foundations of Ayurveda.

• •Panchamahabhuta theory and its implications in Āyurveda:

Every constituent of human body is made of Panchamahabhuta. The five mahabhuta as per the Samkhya philosophy are Pruthvi, Apa, Teja, Vayu, Akasha. This principle has been accepted by Ayurveda and every dravya as per Ayurveda has the Panchamahabhuta constitution. The physiological as well as the pathological parameters can be assessed by means of the Panchamahabhuta theory and evidence of normalcy and abnormality of individual Mahabhuta as per the Ayurveda philosophy. Hence a surgeon has to deal with the patient and the disease even by means of the Panchamahabhuta theory and accordingly diagnostic and therapeutic decisions may be taken. This aspect is having substantial importance as far as the preventive aspect and non recurrence of disease is concerned.

• •Pedagogy of Ayurveda and Code of Conduct for teachers and scholars:

Sushruta specifically mentions about do and don't for any surgeon and surgical students. There are guidelines about the methods of teaching and code of conduct for the students and as well as the Vaidya performing any surgery. The code of conduct involves the disciplined and decent behavior of Surgeon towards king (government), patients, fellow collogues, students and other citizen including the women. Also to be a good surgeon is not only limited to theoretical and practical skills, but there are spiritual, emotional, intellectual and ethical dimensions to it.

• •Space, time and directionality:

Sushruta gives importance to the space, time, direction etc. At the time of performing any procedure or even at the time of learning surgery the time, season etc. has to be taken into account. The space here can be taken by various meanings. It is the space, at the place where surgery is being performed; and also it is the space within the human body, where a surgeon must have the proper idea of space and direction while performing the action within the tissues and cavities of human body.

• •Universe and human relationship:

The fundamental philosophy of Ayurveda is based upon the universe and human interrelationships. Hence a surgeon as well as a physician must have the idea of natural laws which are mentioned as Dravya (matter), Guna (property), Karma (action), Samanya (similarity), Vishesha (dissimilarity), Samavaya (inseperabality), Abhava (absence).

• •Ethical guidelines of practice:

There are guidelines given to all practitioners which are almost similar to the currently existing ethical standards of practice. This includes integrity towards patients and profession. This also includes gentle behavior and integrity towards the government and not to involve in any kind of unethical act in practice.

• •Astronomical aspects in surgical practice:

Sushruta gives importance to planetary combinations and 'Tithi' that is specific period as per the lunar month for performing the procedures. This is not seen in modern medical practice. A surgeon has to identify the good and bad planetary combinations. Though it appears superstitious, there are multiple such references in text and this can be a topic of detailed research.

• •Fundamental principles of Ayurveda philosophy:

It is pertinent to note that, there is influence of Darshanas on Ayurveda. The fundamental principles are built based on the Samkhya and Nyaya philosophy where the twenty four principles of Samkhya and the Pramana of Nyaya play major role. The natural laws are the base on which the philosophy of Dosha-Dhatu- Mala has been formulated. The physiology of Ayurveda is based upon these fundamental principles which are mentioned in Charaka and Sushruta samhita.

• •Pramanas:

Pramana and sixteen Nyaya categories form the major epistemological inquiry as well as the scientific method in Ayurveda. There are mainly five important Pramanas used by Ayurveda, those are Pratyaksha, Anumana, Upamana, Yukti and Shabda. These form the empirical and rational base of the scientific inquiry of Ayurveda. This is applicable to the surgery subject as it is.

In practice of surgery, logic and ethics play major role. In the process of diagnosis and therapeutics, the rationality and cause effect relationship need to be explored by the surgeon. Also the logical reasoning in the process of diagnostics and therapeutics are substantially important. As per the Indian epistemology, Pramana especially Pratyaksha, Anumana and Yukti are the means by which a surgeon has to reach the decision and perform the act. The important factor about surgery is that, there is no scope for any kind of trial and error, and whatever has to done, is to be done by precision, accuracy and perfection. There are similarities in ancient and modern surgery as far as the logical reasoning, causality, ethics, asepsis, instrumentation, code of conduct etc; but differences happen at the level of fundamental principles. Anatomical integrity and functional organisation, both are the key factors for the surgical discipline, may be ancient or modern. Modern surgery tries to find the mechanism by which the anatomical integrity and functional organisation gets disturbed; and tries to correct it by the best possible medicinal or surgical means, whatever suits best for the underlying condition. But ancient surgery of Ayurveda differs from modern surgery, as it focuses on the fundamental principles like, Tridosha, Dhatu, Mala, Panchamahabhuta, Prakruti, Agni, Sira, Snaya, Sandhi, Marma, Strotas etc., designs the Samprapti (pathogenesis) and gives diagnosis based on these principles. Hence the criteria for surgical intervention do not remain similar in Ayurveda surgery as compared to modern surgery. This creates major difference at the level of practice also. Also the principles of practice of orthopedics, urology, proctology etc. are different than the modern surgery. For example, the drugs disintegrating urinary stones, the bandages for fractures and wounds, Ksharasutra for fistula are the modalities which differentiate Shalyatantra from modern surgery.

Rene Leriche has mentioned about ‘Philosophy of Surgery’ as;

“The person we operate on is not just a physiologic mechanism. He has the properties of thinking, and fear. His poor body shakes with fear if he does not get sympathy from across. Nothing can replace the comforting contact with his operator, the mutual gaze and the absolute belief that surgery is accepted with expectations of definite success (at least assumable). These are such delicate matter that they can not be sacrificed. Creatures made as much of sense as flesh, require understanding and assistance in times of trouble.” [10]

Famous Indian philosopher Debiprasad Chattopadhyaya, in his book by name Science and society in Ancient India discusses about philosophical foundations of Ayurveda, where he describes importance of practice and empirical data as below;

“This hardcore medical science does not segregate theory from practice, knowledge from intervention. The ancient doctors are fully conscious of the role of working hand, which they consciously glorify. This not only enriches the actual therapeutic content of ancient Indian medicine but moreover enriches its theoretical aspect. In other words, in the hard scientific core of Āyurveda also we come across a good deal for enthusiasm for theory. But it is the theory determined basically by the needs of medical practice and the validity of which is required to be tested by actual therapeutic success. Unlike most of the discussions in the Hippocratic tracts, the genuine Āyurvedic theory is not the outcome of pure contemplation of the leisured elites, but of the zeal to interpret a vast amount of empirical data by the working doctors interested in knowing nature for the purpose of mastering it.” [11]

Hence in the context of surgery, there are two aspects; one is, philosophy in surgery, i.e., what is inbuilt philosophical perspective of surgery as a science, and how this philosophy in total enriches the subject. The second is philosophy of surgery, where it is the exploration of subject philosophy to surgery, especially in the domain of logic, epistemology and ethics.

7. Surgery and technology

The process of technology in surgery is from olden times and day by day it is getting enriched and making the discipline stronger. The evolution of the branch surgery happened mainly in last 200 years, after the detailed development of anatomy as a subject. The development of surgery was contributed by the surgeons like John Hunter, Ambrose Pere etc. Invention of anesthesia as a separate branch made surgery easier than before. Before the invention of anesthesia, surgery was more crude and difficult as well. The key to development of modern surgery was development of newer techniques over the period of time and development of high end superspeciality surgeries like heart surgery, brain surgery, minimal invasive surgery, cancer surgery. Definitely, the advances in other branches like radiology, pathology made the disease nomenclature and definition more elaborate, which guided the surgeons to develop the newer techniques to tackle those problems. This process was absolutely with precise understanding of anatomical and physiological variations, so that the best outcomes of the surgery can be offered to the patient. Technological advances contribute to surgery in following ways as examples.

• •Precise understanding of anatomy and physiology
• •Genetic and molecular techniques
• •Diagnostic tests, tumor markers and finding the hidden pathologies
• •Finding of the distant manifestations
• •Newer radiological tools
• •Interventional procedural advances like interventional radiology interventional cardiology, interventional neurology etc.
• •Prognostic information
• •Techniques like chemo-radiation
• •Minimal invasive surgeries and laparoscopy
• •Transplantation
• •Use of fiber optics
• •Endoscopic advances
• •Joint replacements
• •Intraoperative tools like C- arms for effective management of fractures and endoscopic procedures
• •Ventilators and advanced intensive care units
• •Cardiac Catheterisation
• •Antibiotics, vaccines and life saving drugs
• •High end operation theatres
• •Diathermy
• •Robotic surgeries
• •Cardiac valves replacement and cardiac surgeries
• •Stereotactic brain surgery
• •Hormonal treatments
• •Plastic and reconstructive surgery
• •Dentistry
• •Lasers
• •Artificial reproductive techniques
• •Insulins
• •Limb prosthesis etc.
• •Artificial intelligence [[12], [13]].

Much more such examples can be given which have changed the scenario of surgery in last some decades. These advances are giving the best outcomes if used rationally. Overuse and undue use may prove detrimental to the patient. Surgeons should remember that, surgery is the treatment modality and not a fashion and should not be used as a tool to enhance the glamour of surgeon. Technology should not surpass the principles and ethics of surgery. In this regard one excerpt by Rene Leriche is self explanatory;

“Medicine, now in a hurricane of new discoveries, is almost in a dazed situation, with a bit of drunkenness by innovations and analysis, in need of passing into the era of synthesis and breathing under trees of island of Cos. Medicine feels that the advances in technology will result in the disintegration and extinction of the oldest traditions and will lead to a danger that can not be avoided: The danger of forgetting the human, who are in the target beyond their humor, consisting of flesh and sense … Each surgeon should be equipped with the deepest respect for the human being.” [10]

8. Interconnecting surgical science-art-philosophy-technology

Sushruta was a visionary surgeon philosopher. He proposed that a physician (and surgeon) should not rely on only one science and study multiple other sciences to enrich his knowledge and competence. This proposal was with context to the study of sciences existing in olden times like Darshana, astronomy, astrology etc; but it current context the dimensions change and the advances in other natural sciences have to be studied by physician. Obviously modern surgery has adopted the advances and progressed rapidly in last century. As mentioned in the article, Beyond the Scalpel: A Tapestry of Surgical Safety, Precision, and Patient Prosperity (2023); “As we strive for surgical excellence, it becomes clear that safety, precision, and patient well-being are closely connected. The importance of adopting a holistic approach to surgery lies in acknowledging the interdependence of these elements and integrating them into a comprehensive framework that goes beyond the limitations of individual procedures. A comprehensive approach recognizes that surgery is not just a single event but a process that starts when the patient interacts with the healthcare system and continues well beyond the operating room” [14]. Some questions here arise here like.

• •Whether art of surgery is getting replaced by technology or getting strengthened by technology?
• •Whether technology is in alignment with the philosophical perspectives in surgery?
• •Whether technology is in alignment with ethical guidelines?
• •How far artificial intelligence can be adopted in surgery?
• •Whether ancient surgery can adopt the technology?
• •Whether ancient surgery can give inputs or insights for modern surgery?
• •How to interconnect science, art, philosophy and technology?

Probably the best possible answer for above questions is, ‘dialogue’. The science should adopt the technology, but in that glamour should not forget the fundamentals and the clinical art. Doctor has to treat the patient and not the reports. The humanistic attitude can survive with the best clinical examination and the surgical training should not miss this. It is necessary for the experts in the field, to critically analyse the judicious use of the advances; and whether those are not getting overused or underused. There must be clear policy guidelines for those. The stream of Ayurveda should be open to accept the advances and design them appropriately based on the fundamental principles of Ayurveda. Also the dialogue among the scholars of Ayurveda and modern surgery should increase and they should design the best treatment protocols for the management of various surgical conditions. The fundamental principles of Ayurveda can give insights for modern surgery, and the treatment patterns can have major contributions from Ayurveda, if we really interconnect surgical science, art, philosophy and technology.

9. Conclusion

Surgery is the branch of medicine which evolved over a long period and especially in last two centuries modern surgery has made revolutionary change. Surgery is the scientific discipline with the inherent art involved within it. Surgery has its own scientific method and philosophy; and technology has contributed to the precision and accuracy in this discipline. Surgery was existing in the ancient era also and in Indian medicine it is known as Shalyatantra. In currently practiced modern surgery or in the ancient Shalyatantra of Ayurveda; science, art, philosophy and technology inherently existed in surgical discipline. There are certain similarities in modern surgery and Shalyatantra, but also there are philosophical difference due to underlying differences in physiology and pathology. The surgical science involves epistemology, logic, ethics in Indian as well as western perspective. The progress of surgical discipline took place by means of appropriate use of scientific methods and applications of physical sciences. The clinical and interventional approaches involve not only scientific but also the artistic mindset of surgeons. The skillsets like observation, interpretation, inference, analysis, communication are determinants for better surgical outcome. The success of surgery is not limited only to procedure but it includes multiple dimensions which can be mentioned under the broad heading of surgical science, art, philosophy and technology. A surgeon or Shalyatantra specialist has to master these dimensions and then perform the procedure. Hence a surgical student needs to find the interconnections among these at every level of surgical practice.

Source of funding

This research did not receive any specific grants from funding agencies from government, private, commercial or non-profit sector.

Conflict of interest

The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Declaration of genertive AI in scientific writing

The author declares that no generative AI and AI-assisted technologies have been used in the writing process.

Author contributions

SD: Conceptualization, Writing Original draft, Reviewing and Editing, Visualization.