The oldest known surgery is a limb amputation performed roughly 31,000 years ago in what is now Borneo, Indonesia. Skeletal remains discovered in Liang Tebo cave show that a young person had the lower third of their left leg surgically removed, probably during childhood. The individual survived the operation and lived for another six to nine years before being intentionally buried in the cave. Before this 2022 discovery, most historians pointed to trepanation, the practice of drilling or scraping holes in the skull, as the earliest surgery, with specimens dating back roughly 12,000 years.
The 31,000-Year-Old Amputation
A team of archaeologists working in a limestone cave in East Kalimantan, Indonesian Borneo, uncovered the skeleton of a young individual whose left lower leg had been cleanly removed at the distal third. The bone showed clear signs of healing and regrowth, meaning this was not an accident or animal attack but a deliberate operation followed by sustained aftercare. The person lived years after the procedure, walking on the healed limb.
What makes this find so striking is the level of medical knowledge it implies. Whoever performed the surgery had to control bleeding, prevent fatal infection, and manage pain, all without metal tools, antibiotics, or anything resembling a modern operating room. The cave itself sits in a region that also contains some of the world’s earliest known rock art, suggesting a community with complex cultural practices. This single skeleton pushed the timeline of known surgical history back by roughly 24,000 years compared to the next oldest evidence of amputation.
Trepanation: The Most Common Ancient Surgery
Before the Borneo discovery, trepanation held the title of humanity’s oldest surgical procedure, and it remains by far the most widely documented. Trepanation involves removing a section of the skull bone, creating a hole that exposes the membrane covering the brain. The oldest known trepanned skulls, found in North Africa, date to approximately 10,000 BCE. Early European examples are similarly ancient, stretching back to the late Paleolithic period. Excavations near Jericho in the Near East have produced specimens from roughly 8,000 to 6,000 BCE, and trepanned skulls have turned up on every inhabited continent.
The purpose of these operations is still debated. Some skulls show evidence of fractures near the surgical site, suggesting trepanation was used to treat head trauma by relieving pressure from bleeding or swelling. Others show no signs of injury at all, which has led researchers to speculate about ritualistic or spiritual motivations. What is clear from the bones themselves is that many patients survived. Healed bone around the edges of the hole proves the person lived long enough for regrowth to occur, sometimes for years or even decades after the procedure.
Prehistoric surgeons performed trepanation using sharpened flint and obsidian tools. Obsidian, a volcanic glass, fractures into edges so fine that some modern eye surgeons still prefer obsidian blades over steel scalpels for delicate procedures. Stone Age practitioners used scraping, cutting, and drilling techniques to remove bone, and the variety of methods found across different cultures suggests the skill was independently developed many times around the world.
Early Dental Surgery
Teeth were another early target. At the Neolithic site of Mehrgarh in Baluchistan, Pakistan, archaeologists found eleven drilled molar crowns from nine adults buried between 7,500 and 9,000 years ago. The holes range from 1.3 to 3.2 millimeters in diameter and up to 3.5 millimeters deep, drilled into the chewing surfaces of first and second molars. Smoothing around the margins of each hole confirms that these were living patients who continued eating and chewing after the procedure. Four females, two males, and three individuals of unknown sex received this treatment, suggesting it was a widespread practice in the community rather than an isolated experiment.
Mehrgarh sits along the main route connecting Afghanistan to the Indus Valley, a corridor that saw heavy trade and cultural exchange even in prehistory. The drilling was likely performed with a bow drill tipped with flint, a tool already in common use for bead-making in the region. Whether the drilling was meant to relieve the pain of cavities or served some other purpose is unclear, but the precision and consistency across multiple patients points to a genuine tradition of dentistry thousands of years before written records.
The First Surgical Textbook
The earliest detailed written account of surgery comes from India. The Sushruta Samhita, composed around the 6th century BCE, describes over 300 surgical procedures organized into eight categories: excision, scarification, puncturing, exploration, extraction, evacuation, draining, and suturing. It covers an extraordinary range of operations, from tooth extraction and cauterization to hernia repair, Caesarean section, removal of bladder stones, and management of intestinal obstruction. Orthopedic techniques for setting fractures, relocating dislocated joints, and even fitting prosthetics are included.
The text also contains the earliest known description of cataract surgery. The technique, called couching, involved using a curved needle to push the clouded lens of the eye downward and out of the line of sight. It did not remove the cataract but displaced it enough to partially restore vision. The procedure was observed in India well into the colonial era, and Western physicians who witnessed it noted that while outcomes were inconsistent, the fact that it worked at all was remarkable.
Sushruta’s text also describes a method for reconstructing a nose using a flap of skin from the forehead or cheek, a procedure now recognized as one of the earliest forms of plastic surgery. Students learning surgery practiced incisions on watermelons, leather bags filled with water, and animal bladders before operating on people.
Closing Wounds and Managing Pain
Stitching wounds shut is nearly as old as cutting them open. Throughout history, surgeons have closed incisions with linen thread, animal tendons, silk, cotton, horse hair, copper wire, and even gold thread. One of the more inventive methods involved giant ants. A practitioner would hold the ant close to the wound so its powerful jaws would bite the edges together, then decapitate the insect, leaving the locked jaws in place as a natural staple. This technique appears in medieval Arabic medical texts, but similar practices likely existed much earlier.
The Greek physician Galen, working in the 2nd century CE, was the first to describe using processed animal intestines as absorbable suture material. He developed the technique while treating injured gladiators, twisting sheep intestines into thread-like strands. This material, later known as catgut, remained a standard suture material into the 20th century.
Pain control during ancient surgery relied heavily on plants. Roman-era physicians used cannabis, opium, and extracts from the nightshade family, including mandrake and henbane, to produce unconsciousness or at least indifference to pain. Mandrake root was commonly mixed with opium and administered as powders, poultices, drops, inhalations, or tablets. These plants contain compounds that depress the central nervous system, and in high enough doses, they could render a patient unconscious. By the Byzantine period, these herbal sedatives had been refined into standardized preparations used specifically for surgical procedures, stripped of the religious rituals that had accompanied their use in earlier Greek practice.
What is not known is how Stone Age surgeons managed pain during trepanation or amputation tens of thousands of years ago. The Borneo amputation in particular required the patient to survive not only the cutting but also a prolonged recovery, which implies some form of wound care and possibly pain relief that left no trace in the archaeological record.