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Introduction: Ayurveda, the ancient Indian system of medicine, emphasizes a holistic approach to health, including medical, para-surgical, and surgical interventions. Among these, Shastra Karma (surgical procedures) represents the pinnacle of therapeutic interventions, as detailed extensively in the Sushruta Samhita. This text not only provides descriptions of surgical techniques but also classifies instruments, methods of wound management, and perioperative care, establishing Ayurveda’s pioneering role in the history of surgery. Methods: A comprehensive literature search was conducted using classical Ayurvedic texts (Sushruta Samhita, Charaka Samhita, Ashtanga Hridaya), commentaries, and modern translations. Electronic databases including PubMed, Scopus, and Google Scholar were searched for relevant studies published between 1990 and 2025. Keywords included “Shastra Karma,” “Ayurvedic surgery,” “Sushruta,” and “ancient surgical practices.” Both clinical and experimental studies, reviews, and historical analyses were included. Exclusion criteria comprised non-English studies without translation and publications lacking methodological clarity. Results: The review revealed that Shastra Karma encompasses a wide spectrum of interventions such as excision, incision, drainage, foreign body removal, lithotomy, and reconstructive procedures. Evidence supports the efficacy of Ksharasutra therapy for fistula-in-ano and Agnikarma for musculoskeletal disorders, validating classical concepts through modern trials. Perioperative principles described by Sushruta, including asepsis, anesthesia, and post-operative care, align with modern surgical protocols. However, gaps exist in clinical validation, standardized methodologies, and integration with evidence-based practice. Discussion: The integration of Shastra Karma with modern surgical advancements offers promising prospects for minimally invasive techniques, wound management, and para-surgical therapies. Despite challenges in standardization and global acceptance, Ayurvedic surgery retains significant relevance in contemporary practice.

KEYWORDS: Agnikarma, Ayurveda, Ksharasutra, Shalya Tantra, Shastra Karma