Between 1880 and 1920, surgical knowledge and techniques experienced remarkable advancements globally. However, the medical profession encountered challenges in adapting to these rapid changes. In Australasia, most practitioners (general practitioners) lacked specialized surgical expertise, often relying on what was colloquially termed "nerve" to undertake major surgeries. The formation of the American College of Surgeons in 1913 established a model for organized surgical education and professional standards, sparking interest worldwide, including in Australasia. Professor Louis Barnett of the University of Otago first proposed establishing a similar body in Australia and New Zealand, inspired by his experiences in America. The idea gained momentum during the Eleventh Australasian Medical Congress in Brisbane in 1920 but was initially rebuffed by the British Medical Association (BMA), the governing body at the time. In 1924, after a tour by Dr William Mayo and Dr Franklin Martin, distinguished Australian and New Zealand surgeons were offered a Fellowship in the American College of Surgeons. This event further catalyzed the movement for a local institution. Formal discussions commenced in 1926 when Sir H.B. Devine, Sir George Syme, and Dr. Hamilton Russell corresponded with universities and hospitals across Australasia. A pivotal meeting convened in Sydney in August 1926, leading to unanimous agreement to establish the College of Surgeons of Australasia. In September 1926, the Royal Australasian College of Surgeons was officially inaugurated, with Sir Henry Newland as President and Professor L.E. Barnett and Sir Alexander MacCormick assuming Vice Presidency roles for Aotearoa New Zealand and Australia, respectively.