Few surgeons have embodied the pure pursuit of excellence in anatomy, surgical techniques, medical education, innovation, and patient advocacy as Dr. Robert Liston. He was one of the most prominent surgeons of his era, and his imprint on surgical education continues today.
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“Time me, Gentlemen!” are famous words Dr. Robert Liston usually uttered right before a surgical procedure. The life of Robert Liston tells the tale of how a young surgeon in 19th century Victorian England elevated to become the most daring, courageous, technically gifted, and fastest surgeon of his era. Dr. Liston was just 16 years old when he began medical training under the famed anatomist John Barclay. He would be appointed House Surgeon of the Royal Infirmary in Edinburg four years later. Given his age compared to his peers, Dr. Liston always pointed out that experience and case volume, not age, guaranteed success and proof of ability. Many historical surgical texts always point to the bravery and bravado of Dr. Liston, such as his intimidating and argumentative personality, daring ability to take on the most difficult of surgical cases, or the apocryphal lower extremity amputation case with a 300% mortality. Being the showman he was, Dr. Liston never shielded away from challenges or competition and was unapologetic in his disapproval of surgical practices he considered inferior.


His nickname, “The Fastest Knife in the West End,” continues in surgery annals today, with one of his above-the-knee amputations only lasting 30 seconds from incision to final suture. Dr. Liston’s U-shaped flap technique revolutionized limb amputation surgeries, and the Liston knife (a long, double-sided blade) became the standard instrument for limb amputations. Dr. Liston also made many contributions to aseptic surgery and performed Europe’s first surgery under anesthesia.
The most lasting aspects of the life of Dr. Liston that permeate today were his dedication to surgical excellence, innovation, ethics, and patient advocacy. During an era that predated general anesthesia, blood transfusion, and asepsis, where patients walked into hospitals with the fear of certain death, Dr. Liston understood the justified terror of surgical intervention. He took seriously the agony and pain patients had to bear during a surgical procedure. Thus, his call for surgeons to have a thorough knowledge of anatomy and pathology, make accurate diagnoses, and intervene surgically, when indicated, with swift, precise, and unwavering competence in operative technique.



Historical Significance:
A complete picture of Dr. Liston is a surgeon who was never complacent, never afraid to step into the unknown, and one who knew that true success came from study and experience. One who was a compassionate provider, always doing his best to attend to the minds and feelings of his patients. These attributes are epitomized in recipients of the Liston Medal for Surgery at University College Hospital, London, England. While such an award is not commonplace in the United States today, these attributes (which embody the true legacy of Dr. Liston) should be sought out by every surgical provider.


Eliel Arrey MD MBA


Eliel Arrey, MD., MBA., is a health advisor, business advocate, entrepreneur, educator, and surgeon with a passion for Breast Oncology, Oncoplastic and Cosmetic Surgery. History of Surgery series showrunner. He has been an educator for over 15 years and has vast experience teaching undergraduate students, nursing students, medical students, and resident physicians. Dr. Arrey is a physician at Grady Memorial Hospital in Atlanta and a Morehouse School of Medicine physician. He also serves as a faculty member at Kaplan, teaching Neurology and Surgery review courses to medical students worldwide. He is currently a PhD candidate in organizational leadership at Columbia International University.



References:

1. Brockbank, Edward M. “The Edinburgh Surgical School.” Annals of the Royal College of Surgeons of England 10, no. 4 (1952): 242–49. [This paper provides insights into Dr. Robert Liston’s tenure at the University of Edinburgh and his contributions to surgical education.]
2. Rosenberg, Charles E. The Care of Strangers: The Rise of America’s Hospital System. JHU Press, 1995. [This book discusses the impact of Dr. Liston’s use of anesthesia on the development of surgery, particularly in the United States.]
3. Whalen, Robert C. “Robert Liston and his eyewitnesses.” Surgery 140, no. 6 (2006): 1002–7. [This article delves into various surgical cases performed by Dr. Liston, including anecdotes about his speed in the operating room and the consequences of his haste.]
4. LeFanu, James. The Rise and Fall of Modern Medicine. Basic Books, 2001. [This book provides context on the historical significance of Dr. Liston’s contributions to surgery and the evolution of medical practice.]
5. Paget, Stephen. “The Only Operation with a 300 Percent Mortality.” The British Medical Journal 2, no. 3920 (1964): 19–21. [This article discusses the infamous case of Dr. Liston’s surgical mishap, shedding light on the consequences and lessons learned from the incident.]

Dr. Robert Liston (1794–1847) was a Scottish surgeon renowned for his remarkable speed and dexterity in the operating theater during the early 19th century. Born in Linlithgow, Scotland, Liston studied medicine at the University of Edinburgh, where he eventually became a professor of surgery.
Liston's surgical career was marked by numerous pioneering procedures and techniques. Notably, he was among the first to perform operations under general anesthesia, using ether, which revolutionized surgery by reducing patients' pain and allowing for more complex procedures. In 1842, Liston successfully performed the first amputation under ether anesthesia, a significant milestone in the history of surgery.

This element of the life of Dr. Liston is might be apocryphal but cited but it is cited in multiple sources so we will cover it.  Liston was also known for his remarkable speed in the operating room. His famous motto was "Time me, gentlemen!" as he completed surgeries with astonishing swiftness. However, his rapid pace sometimes led to unfortunate accidents, such as the notorious case of the "The Only Operation in History with a 300 Percent Mortality." During this operation to remove a tumor, Liston accidentally severed the fingers of his assistant and slashed through the coattails of a spectator, both of whom later died from infections, while the patient also succumbed to gangrene.
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Despite his occasional mishaps, Liston's contributions to surgery were substantial, and his legacy endures in the annals of medical history. His emphasis on speed and efficiency helped pave the way for modern surgical techniques, and his advocacy for anesthesia transformed the field, making surgery safer and more humane.

Dr. Robert Liston's commitment to patient care was multifaceted, reflecting both the ethos of his time and his personal dedication to advancing the field of surgery while prioritizing the well-being of his patients. Despite his reputation for speed and efficiency in the operating room, Liston's commitment to patient care extended beyond mere surgical skill.

Firstly, Liston was an early advocate for the use of anesthesia in surgery. Before the advent of ether anesthesia, surgical procedures were often excruciatingly painful and carried significant risks of shock and infection. Liston recognized the importance of mitigating patients' suffering and improving their outcomes through the use of anesthesia, and he played a pivotal role in popularizing its adoption in surgical practice.

Additionally, Liston's emphasis on speed in the operating room was not solely motivated by a desire for efficiency but also by a concern for minimizing patients' exposure to the risks of surgery. By completing procedures quickly, Liston aimed to reduce the duration of anesthesia and the likelihood of complications arising from prolonged surgical intervention. While his rapid pace occasionally led to unfortunate accidents, such as the case of the "Only Operation in History with a 300 Percent Mortality," Liston's intention was always to prioritize the well-being of his patients.

Moreover, Liston's commitment to patient care was evident in his broader advocacy for advancements in surgical technique and patient safety. As a professor of surgery at the University of Edinburgh, he trained numerous students, emphasizing the importance of meticulous technique, thorough anatomical knowledge, and compassionate patient care. Liston's contributions to surgical education helped shape generations of surgeons who shared his commitment to the highest standards of patient care.

In conclusion, Dr. Robert Liston's commitment to patient care was characterized by his advocacy for anesthesia, his efforts to minimize patients' suffering and risks during surgery, and his dedication to advancing surgical practice and education. While his legacy includes anecdotes of surgical mishaps, Liston's overarching goal was always to improve patient outcomes and alleviate their pain, leaving a lasting impact on the field of surgery and patient care.

​References:

1. Brockbank, Edward M. "The Edinburgh Surgical School." Annals of the Royal College of Surgeons of England 10, no. 4 (1952): 242–49. [This paper provides insights into Dr. Robert Liston's tenure at the University of Edinburgh and his contributions to surgical education.]
2. Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System. JHU Press, 1995. [This book discusses the impact of Dr. Liston's use of anesthesia on the development of surgery, particularly in the United States.]
3. Whalen, Robert C. "Robert Liston and his eyewitnesses." Surgery 140, no. 6 (2006): 1002–7. [This article delves into various surgical cases performed by Dr. Liston, including anecdotes about his speed in the operating room and the consequences of his haste.]
4. LeFanu, James. The Rise and Fall of Modern Medicine. Basic Books, 2001. [This book provides context on the historical significance of Dr. Liston's contributions to surgery and the evolution of medical practice.]
5. Paget, Stephen. "The Only Operation with a 300 Percent Mortality." The British Medical Journal 2, no. 3920 (1964): 19–21. [This article discusses the infamous case of Dr. Liston's surgical mishap, shedding light on the consequences and lessons learned from the incident.]