The computed tomography (CT) scanner has become an invaluable tool for surgeons, used in diagnosis, staging and characterisation, surveillance, operative planning, trauma assessment, and hybrid surgical procedures. It was the first imaging modality to reliably produce axial images and remains the most accessible and widely used form of cross-sectional imaging. The mathematical principles underpinning CT reconstruction were first described by Allan Cormack in the late 1950s. These concepts were independently advanced by Godfrey Hounsfield, who developed a practical system integrating X-ray acquisition with computer-based image reconstruction. The first clinical CT scan was performed in London in 1971 to assess intracranial pathology and, while primitive by modern standards, demonstrated the potential of cross-sectional imaging. Over the subsequent decade, rapid advances established CT as a cornerstone of neuroimaging, and improvements in image resolution and acquisition speed enabled effective whole-body imaging. CT was first incorporated into widespread surgical practice through trauma care, with guidelines recommending its use in haemodynamically stable patients during the 1990s. Also, around this time, CT became central to the assessment of suspected intracranial pathology and cancer staging. As access to CT scanners improved in the early 21st century, the technology became embedded as a default first-line investigation across numerous surgical guidelines and clinical pathways. Ongoing refinement has since extended its role beyond diagnosis, with contemporary applications including advanced angiography, three-dimensional reconstruction, and intraoperative use within hybrid operating theatres. The significance of CT was recognised with the awarding of the Nobel Prize to its creators, reflecting its status as a major medical innovation and its impact on surgical practice and patient outcomes.

Through time, humans have conveyed understanding through art. From symbolic cave drawings, abstract medieval imagery, to realism and humanism during the Renaissance. As art evolved so has the knowledge of anatomy. Early anatomical knowledge is evident in embalming practices dating back to Ancient Egypt. Herophulis (200BC), is credited as the first person to conduct human dissections, but in the Middle Ages human dissection remained taboo. It was not until the 12th century when rare Papal approval was given to universities for cadaveric dissections to further anatomical teaching. The study of anatomy has always been intrinsically tied to visual representation. As an inherently visual discipline, anatomy relies on illustration to communicate form and function. Renaissance anatomical illustrations are attributed Leonardo Da Vinci and Michelangelo. These artists, alongside anatomists such as Andreas Vesalius, produced detailed depictions of the human body that advanced anatomical understanding. Despite the increased precision, these illustrations remained confined to two-dimensional space and were limited in their ability to convey the spatial complexity and relationships of anatomical structures. Moveable or pop-up books is a medium that overcomes the challenge of two-dimensional depictions. The first moveable book is attributed to a poet of the 12th century Ramon Llull who used revolving discs to illustrate his philosophical theories. By the 16th century, anatomist adopted similar techniques for educational purposes. These include works by Andreas Vesalius and Johann Remmelin, both utilised layered, liftable images to enable sequential, three-dimensional exploration of the human body. These paper-based innovations laid the foundation for increasingly dynamic modes of anatomical visualisation. This paper will explore the history of the art of illustration, alongside the development of anatomy and how the two have intersected to give rise to pop-up anatomy books.

Trauma surgery is among the oldest technical disciplines in medicine. Concepts such as airway compromise, haemorrhage control, and wound dressing are pervasive throughout the earliest texts in Western Literature: the Homeric epics, the Iliad and Odyssey (8th century BCE). To understand the roots of modern trauma surgery, we examine these texts to uncover what our ancestors understood of this complex speciality. Homer demonstrates recognition of airway and cervical trauma as immediately fatal and tactically decisive. When Ajax strikes Hector to the neck “the breath left him, and he sank to his knees, coughing blood” (Iliad 7.271-272). Injuries to this region are portrayed as unsurvivable, reflecting an understanding its the anatomical importance. Principles of wound management are often described. Treating Eurypylus, Patroclus “cut the arrow from his thigh with a knife and washed it with warm water” (Iliad 11.844-848), indicating careful foreign-body extraction and irrigation. Similarly, Machaon treats Menelaus by removing the arrow and applying “soothing medicines which Chiron once gave to Asclepius” (Iliad 4.218-221), suggesting the use of prepared topical therapies with analgesic and antiseptic intent. Haemostasis is a recurring concern. Patroclus applies “a bitter root that eased pain and stopped the bleeding” (Iliad 11.846-847), corresponding to yarrow, while Helenus’ arm wound is managed by application of “a well-twisted bandage” (Iliad 13.599-600), demonstrating an early understanding of the tourniquet. Homer also articulates the value of wartime physicians. When Machaon is wounded, Idomeneus observes: “A healer is worth many men, for he knows how to cut out arrows and apply remedies” (Iliad 11.514-515), representing the earliest recorded recognition of the value of trauma surgeons. It is clear that trauma surgery is not just a modern science, but an art innate to humanity itself, and, as Homer suggests, perhaps one bequeathed upon us by great Asclepius himself.

Contemporary head and neck cancer management is based on multi-disciplinary team (MDT) decision-making, representing a significant departure from the historically individual surgery centred model of care. The benefits of the MDT system are well recognised but how and why this was necessitated or became a standard of care is equally worth acknowledging. The evolution of the head and neck MDT is examined to provide insight into both the science of developing and recognising alternative treatment modalities and the art required to sustain effective collaboration in both otolaryngology and other surgical fields. Advances in diagnostic imaging and pathology as well as widespread acceptance of radiotherapy and systemic therapies as viable primary and adjuvant treatment modalities for head and neck cancer have increased the complexity and challenged feasibility of patient management by a single surgical team. Simultaneously, evidence supporting the advantages of coordinated care such as faster diagnosis to treatment time, improved treatment outcomes and higher patient satisfaction has amassed, further expediting the formalisation of the MDT. Establishment of MDTs transformed collaboration from an informal professional courtesy into a standardised and documented process. MDT records demonstrate this process and illustrate regular participation from surgical, pathological, radiological, oncological and allied health disciplines and emphasise how collaborative decision-making has become embedded within routine surgical practice. However, the development of the MDT does not resolve all challenges of collaboration – leadership, communication and professional culture continue to shape how effectively MDTs function in practice. The history of the head and neck MDT therefore highlights the dual nature of collaboration in surgery: a scientific response to increasing clinical complexity, and an art that depends on human interaction. Understanding this historical evolution provides insight into how collaboration is learned, executed and maintained within modern surgical care.

Background: Burns are among the earliest recorded traumas in medical history, with their care reflecting some of humanity’s first forays into empirical healing and reconstructive techniques. Across cultures, responses to thermal injury were shaped by observation, environment, and enduring knowledge traditions, many of which anticipated principles central to modern burn care. Aims: This study traces the evolution of burn treatment across civilisations, with particular focus on Indigenous Australian and ancient global practices. Discussion: Among the longest continuous healing traditions, Aboriginal Australian approaches combined plant-based medicines such as crushed tea tree leaves with smoke therapy and spiritual care. These methods reflect a sophisticated understanding of antimicrobial properties, pain relief, and the social dimensions of recovery, principles echoed in today’s holistic models of care. Similar threads appear across ancient texts. Egyptian and Greek healers applied honey, wine, and resins to burns, harnessing their protective and antiseptic qualities. In 9th-century Persia, Al-Razi described water immersion for burns, one of the earliest documented instances of first aid. In Renaissance Europe, Paré and Fabry attempted excision and escharotomy, intuitive yet limited by the pre-antiseptic era. The history of burn care is not linear, but a mosaic of shared insight, rediscovery, and forgotten innovation. Recognising the role of Indigenous Australians, on whose land this conference is held, alongside other global traditions, enriches our understanding of surgical heritage and affirms the lasting value of diverse knowledge systems in shaping contemporary burn care.

Background Prior to the development of effective local anaesthesia, even minor surgical procedures involved the significant risks of inhalational general anaesthesia. In the early 20th century, local anaesthetic techniques were unreliable, not widely known and restricted to limited small nerve blocks. In 1908, German surgeon August Bier described a method of producing whole limb anaesthesia through vascular isolation and intravenous administration of local anaesthetic – a technique now known as intravenous regional anaesthesia (IVRA). Technique Informed by his pioneering work in spinal anaesthesia in 1898, Bier’s block involves the exsanguination of a limb, application of a tourniquet, and intravenous injection of local anaesthetic, originally a dilute cocaine solution, into the isolated vascular compartment. Anaesthesia is rapid, dense, and reversible, resolving predictably with tourniquet release. It provides theoretically indefinite anaesthesia as there is no drug metabolism or washout as long as the tourniquet remains applied – however, functionally the onset of tourniquet pain limits the procedure to approximately 20-40 minutes. Historical and clinical significance In a time when both general and local anaesthesia had significant risks, Bier’s innovative technique provided a simple, effect and low-risk anaesthesia for extremity surgery. It did not demand additional expertise beyond establishing intravenous access, and maintained relevance despite the nerve blocks in the early 1900s, which remained limited by issues of neurovascular injury and need for a high level of operator skill. Until the widespread implementation of ultrasound guidance in the early 2000s, Bier’s block remained an effective and accessible option, especially in resource- or expertise-poor settings. Conclusion More than a century after its introduction, Bier’s block endures as both a practical technique and a historical marker of cross-disciplinary innovation beyond the surgical skillset.

Background: The discovery of the pulmonary circulation represents a transformative journey in medical history, yet the contributions of key pioneers remain unevenly recognized. Although William Harvey is universally credited for his 1628 description of blood circulation, earlier groundbreaking descriptions by Ibn al-Nafis (1210-1288) and Michael Servetus (1511-1553) in countering Galen’s (129-216AD) long-established dogma deserve greater recognition. Methods: A narrative review of historical medical literature, including primary sources and contemporary scholarship on the evolution of circulatory physiology from Galen through the European Renaissance. Findings: Ibn al-Nafis described the pulmonary circulation in 1242, correctly rejecting Galen's septal pore theory and anticipating proof of there being pulmonary capillaries some 400 years before Marcello Malpighi (1629-1694). However, there is some recent evidence that suggests Persian physicians during the Sassanid era (224-637 AD) may have recognized pulmonary circulation even earlier. Servetus independently described the pulmonary circuit in 1553, though debate persists about possible transmission of Ibn al-Nafis's work through Arabic-to-Latin translations. Harvey's 1628 experimental demonstration established the closed-loop circulation, apparently without knowledge of his predecessors, as Ibn al-Nafis's work remained untranslated from Arabic until 1924. Conclusions: The history of the discovery of the pulmonary circulation exemplifies how scientific progress depends on challenging established dogma across cultures and centuries. However, the contributions of Ibn al-Nafis, Servetus, and possibly their predecessors, deserve recognition alongside Harvey and underline why historical research should be inclusive of other cultures and languages and avoid being anglo- or euro-centric.

Background: Pancreaticoduodenectomy (PD) remains one of the most complex abdominal operations, demanding high-level judgment, anatomical mastery, and refined technique. Its contemporary feasibility rests on a long sequence of incremental advances, shaped decisively by three seminal pioneers. Synopsis: The evolution of PD spans experimental exploration, early operative innovation, and progressive refinement of reconstruction. Foundational work included cadaveric and experimental studies demonstrating the plausibility of duodenal and pancreatic resections (e.g., Desjardins, 1907; Sauvé, 1908; Dragstedt, 1918), followed by pioneering approaches to pancreatic anastomosis and restoration of gastrointestinal continuity (e.g., Coffey and Kehr, 1909; Hunt, 1941). Against this backdrop, three figures stand out for establishing the conceptual and technical framework of modern PD: William Stewart Halsted, Walther Carl Eduard Kausch, and Allen Oldfather Whipple. Halsted reported the first successful resection for carcinoma of the ampulla of Vater (1899) and advanced the principle of en bloc excision for periampullary malignancy. Kausch, in 1909, performed a more comprehensive resection than prior contemporary reports and described methods of reconstruction, prompting later recognition that the operation is historically best termed the Kausch–Whipple procedure. Whipple’s landmark 1935 report of a two-stage PD represented a major step toward reproducibility and safety, demonstrating that pancreatic surgery could be undertaken with acceptable outcomes. Parallel advances in perioperative care further transformed the risk profile of PD and accelerated its adoption. Significance: Once considered prohibitive because of the pancreas’ deep retroperitoneal location and surgical risk, PD became achievable through the cumulative work of multiple innovators—anchored by the “Magnificent Three.” Their legacy not only established PD as a cornerstone of HPB surgery but also placed one of surgery’s most demanding procedures within the reach of trained teams worldwide.

The surgical stapler represents one of the most significant technological advances in modern surgery. What was once a heavy, expensive, and impractical tool has evolved into a range of highly specialised devices that are fundamental to anastomotic formation in contemporary minimally invasive surgery. The first mechanical stapling device was developed by Hümér Hültl in collaboration with Victor Fischer in 1908 and is thought to have been designed for distal gastrectomy. Although innovative, it failed to gain widespread popularity due to its cumbersome and time-consuming application. Despite this, the original design incorporated three principles that remain central to modern stapling technology: B-shaped staples, double staggered rows, and the use of fine wire as staple material. Incremental advances followed; however, significant progress occurred after the Second World War when the Soviet Union established a dedicated institute for the development of surgical apparatus, leading to systematic production of staplers in varying sizes and configurations for different tissue types. By the 1960s, Soviet-designed staplers were introduced into the United States, where refinements by American manufacturers produced devices that were simpler, lighter, and more reliable. The introduction of disposable staple cartridges, and later single-patient-use staplers, facilitated widespread adoption and standardisation of stapling techniques. In contemporary practice, surgical staplers are highly sophisticated instruments incorporating powered firing mechanisms, integrated sensors, and real-time feedback, improving consistency and reducing user variability. While the fundamental design principles of the surgical stapler have remained consistent for over a century, ongoing technological advances have resulted in substantial improvements in safety, reliability, and surgical outcomes.