used instead of ligatures. surgical techniques like tracheal intubation and tracheotomy date back to ancient rome. the ancient roman writer aulus gellius described a technique that functioned similarly to bariatric surgery. which is conducted to reduce the weight of obese individuals. in this technique the surgeon would forcefully contract the stomach, thus limiting the passage of food. catgut sutures were used by the ancient romans as early as the 2nd century ce. they also used sutures with metallic hooks. celsus discusses other kinds of suturing techniques in his medical literature. he wrote that the wounds were to be stitched up. roman doctors used linen, wool, silk, hair, and clips to seal wounds. tonsillectomies and mastectomies the ancient romans practiced tonsillectomies. roman surgeons would use their fingers or a blunt hook to separate the tissue by the tonsils. vinger mouthwash was used to induce hematopoiesis, or the stable production of blood cells. following the surgery, the tonsils were cut out. it was common for patients to profusely bleed following the procedure. roman surgeons usually would also remove the vulva. to treat breast cancer, the romans had an operation similar to a mastectomy. it would remove the pectoral muscles of the sufferer. galen wrote that doctors should cut through healthy tissue around the infected tissue. ensuring that all cancerous material was removed. this operation could also be used as a punishment. for example, agatha of sicily was a christian saint who had her breasts cut off. these ancient roman dental forceps would have been used during tooth extractions. tooth extraction it is unclear which roman profession or professions would have performed dentistry. there may have been medical specialists trained to perform dental procedures, it is also possible that dentistry was practiced as a subset of other professions, such as barbery. tooth extraction is an oral surgical procedure conducted to remove teeth. in ancient rome, it may have been practiced by specialists who were not associated with any other medical professionals in ancient rome. this practice required teeth to be extracted softly to avert the danger involved. this danger also resulted in the practice becoming rare. ancient literature describes another process dedicated to extracting teeth. in this process, the tooth would be grabbed and rocked until it could be removed with hands. another practice involved cutting the gum and bone surrounding a tooth and then extracting it. celsus recommended that physicians should also extract the bone near the teeth and that they should refuse to extract children's teeth unless they were preventing adult teeth from growing. other techniques the ancient surgeon dioscorides used mandragora offcinarum as a painkiller during surgery. other substances were used, such as opium, henbane, wine, belladonna, and alcohol. anal fistula were treated by passing probes through the anus, then once it was drawn out, a linen thread was placed into it. following this the ends of the linen were tied to grip the skin by the fistula. to treat stab wounds in which the intestines fell out of the body, the surgeon would first examine the injuries to the intestines and their color. the large intestine was sutured, and if either intestine was pallid, black, or livid the patient was laid on their back with their hips raised. if the wound was too narrow to allow for an easy replacement of the intestines, the surgeon would cut it until it was "sufficiently wide." if the intestines were too dry, they were coated in water. following this, an assistant would use their hands or hooks to separate the margins of the wound. then the skin would be stitched with two rows of stitches. projectiles were removed by enlarging the wound area with a scalpel, then using a forceps to drag the projectile out. to treat abscesses a scalpel or a spathion was used to make linear incisions. afterwards, all the skin covering the pus was cut off. following the surgery, the area was disinfected with honey. another procedure involved using tongue depressors or spathomeles to depress the tongues of adult patients. following this, the abscess was opened with a probe or a needle knife.