Surgery in the US, less hindered by the negative pressure camp, was quicker to adopt endotracheal intubation, the use of bellows and ultimately endobronchial lung isolation ventilation. He pioneered the first tank ventilator in 1907, allowing surgeons to operate on an open thorax with the patient’s head and anesthesiologist literally in another room. Sauerbruch, in Germany, with the support of the internationally acclaimed Von Mikulicz, persisted for many years operating in expensive negative pressure chambers. Positive pressure ventilation was not immediately seen as a solution to advance intra-thoracic surgery and those who did use it were divided between the use of face-masks, intra-pharyngeal and endotracheal insufflation. The problem of pneumothorax however plagued the operative and the post-operative period. The animals survived surgery and returned to health. Block of Danzig described many lung resections in rabbits and dogs. Tuffier performed the first partial lung resection that consisted of placing a ligature on the lung, excising and suturing the lung to the periosteum., Initial works demonstrating the feasibility of lung resection came from extensive animal experimentation. Lung surgery prior to the late 1800’s was largely rare reports of draining deep abscesses, resecting prolapsing gangrenous tissue after trauma and resecting portions of the chest wall with small segments of accompanying lung.
The principles of intra-thoracic and intra-pleural surgery developed during the early 20th century with significant progress in a short time. Thoracic surgery and lung resection, however, proved more difficult to advance than other surgical specialties due to the problem of pneumothorax. Understanding of antisepsis, after Lister’s first report in 1867 and development of anesthetic techniques, in particular chloroform and ether made way for early successful surgical intervention. Early surgical interventions were highly morbid, painful and deadly.
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