General surgery

This page is about the surgical specialty. For the goregrind band, see General Surgery (band)

^{A surgeon operating.}

General surgery, despite its name, is a surgical specialty that focuses on abdominal organs, e.g., intestines including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists). They also deal with diseases involving the skin, breast, and hernias. These surgeons deal mainly in the Torso. It is jokingly referred to by other specialists as the "butts and guts" specialty, because it primarily deals with the digestive tract.

Scope

With the prevalent trend for increasing sub-specialization in today's medical practice, General Surgery has lost most of its former glory and scope. Nonetheless, it continues to be a somewhat competitive, rewarding and demanding specialty in its own right. Until recently, all surgeons in the United States were required to be board certified by the American Board of Surgery in order to progress into further sub-specialty training. However, recently, board certification has been delegated into separate sub-branches, whereby successful completion of a Residency in General Surgery is not necessarily required, but may well be desired - depending on the country and area of practice, as well as the individual sub-specialty.

Many sub-specialties are still part of the General Surgical training program. That is, General Surgeons may sub-specialize into one or more of the following disciplines:

Trauma surgery

In the United States and Canada, the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training and specialty certification in this field alone. General surgeons must be able to deal initially with almost any surgical emergency. Often they are the first port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilise such patients, such as intubation, burr hole, cricothyroidotomy, and emergency laparotomy or thoracotomy to stanch bleeding.

All General Surgeons are trained in emergency surgery. Bleeding, infections, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide. This is most often done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Ruptures of the appendix and small bowel obstructions are other common emergencies.

Laparoscopic surgery

Is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 0.5 to 1 cm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are now repaired mostly laparoscopically. Most bariatric surgery is performed laparoscopically. General surgeons that are trained today are expected to be proficient in laparscopic procedures.

Colorectal surgery

General Surgeons treat a wide variety of minor colon and rectal diseases ranging from inflammatory bowel diseases (such as ulcerative colitis or Crohn's disease)to diverticulitis, gastrointestinal bleeding, hemorrhoids, etc.

Breast surgery

General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy, especially pertaining to the evaluation and diagnosis, of breast cancer

Vascular surgery

General Surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.

Endocrine surgery

General Surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glands just above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists other subspecialty surgeons may assume responsibility for these procedures.

Dermatological Surgery

General Surgeons perform a wide variety of skin-related surgeries ranging from removing suspicious moles to treating major burns. General Surgeons also remove tumors that often grow just below the skin such as fatty tumors or tumors that arise in muscles or other soft tissues. General Surgeons also treat more complex skin or subcutaneous infections including necrotizing fasciitis and will often employ skin grafts to cover defects in the skin resulting from burns, trauma, or infections.

Trends

In the last few years minimally invasive surgery has become more prevalent. Considerable enthusiasm has built around robotic surgery (also known as robotic-assisted surgery), despite a lack of data suggesting it has significant benefits that justify its cost.^[1]

Training

In Canada, Australia, New Zealand, and the United States general surgery is a five- or six-year residency and follows completion of medical school, either MD, MBBS, MBChB, or DO degrees. In Australia and New Zealand, a residency leads to eligibility for Fellowship of the Royal Australasian College of Surgeons. In Canada, residency leads to eligibility for Certification by and Fellowship of the Royal College of Physicians and Surgeons of Canada, while in the United States, completion of a residency in general surgery leads to eligibility for board certification by the American Board of Surgery which is also required upon completion of training for a general surgeon to have operating privileges at most hospitals in the United States.

In the United Kingdom, surgical trainees enter training after five years of medical school and two years of the Foundation Programme. During the two to three-year core training programme, doctors will sit the Membership of the Royal College of Surgeons (MRCS) examination. On award of the MRCS examination, surgeons may hold the title 'Mister' or 'Miss/Ms' rather than doctor. This is a tradition dating back hundreds of years in the United Kingdom that is still in use today. Trainees will then go onto Higher Surgical Training (HST), lasting a further four to five years. During this time they may choose to subspecialise. Before the end of HST, the examination of Fellow of the Royal College of Surgeons (FRCS) must be taken in General Surgery plus the subspeciality. Upon completion of training the surgeon will become a Consultant Surgeon and will be eligible for entry on the GMC Specialist Register and may work both in the NHS and independent sector as a Consultant General Surgeon. However, with the implementation of the European Working Time Directive limiting UK surgical residents to a 48-hour working week there are concerns that upon completion of training UK surgeons will not be confident enough to work independently. The introduction of a sub-consultant grade to enable those who have recently received a UK Certificate of Completion of Training may be necessary.

Subspecialization

In many countries general surgery is a prerequisite for subspecialization in:

• vascular surgery
• thoracic surgery
• cardiac surgery
• plastic surgery
• Surgical Critical Care

See also

• Surgery
• Abdominal surgery
• Surgeon
• Physician
• Traumatology
• Reconstructive surgery

References

1. ↑ Lunca S, Bouras G, Stanescu AC (2005). "Gastrointestinal robot-assisted surgery. A current perspective". Romanian journal of gastroenterology 14 (4): 385–91. PMID 16400356. 

External links

• Association of Surgeons of Great Britain and Ireland
• American College of Surgeons
• Careers in Surgery - Association of American Medical Colleges.
• General Surgeons Australia
• Canadian Association of General Surgeons