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A reference to the situation of a patient lying on an operating table while a surgeon stands over them and operates using a surgical cutting tool (typically a scalpel).
1964 April 24, “France: Operation Royal”, in Roy Alexander, editor, Time, New York, N.Y.: Time Inc., →ISSN, →OCLC, archived from the original on 2009-08-26:
Rumor that De Gaulle [i.e., Charles de Gaulle] was under the knife sped through Paris and the world the next morning. The staff at the Elysee Palace, De Gaulle's official residence, refused for hours either to confirm or deny the story; […] Finally, at 7:15 p.m., a bulletin signed by three doctors said that De Gaulle had been operated on that morning for "a disease of the prostate"— […]
"I don't want to go under the knife again. I had 10 surgeries as a player and many more since," Dykstra said, speaking as though he still had his trademark wad of tobacco in his mouth.