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| Occupation | |
|---|---|
| Names |
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Occupation type | Specialty |
Activity sectors | Medicine,Surgery |
| Description | |
Education required |
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Fields of employment | Hospitals,Clinics |
General surgery is asurgical specialty that focuses onalimentary canal andabdominal contents including theesophagus,stomach,small intestine,large intestine,liver,pancreas,gallbladder,appendix andbile ducts, and often thethyroid gland. General surgeons also deal with diseases involving theskin,breast,soft tissue,trauma,peripheral artery disease andhernias and performendoscopic as such asgastroscopy,colonoscopy and laparoscopic procedures.
General surgeons may sub-specialise into one or more of the following disciplines:[1]
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In many parts of the world includingNorth America,Australia and theUnited Kingdom, the overall responsibility fortrauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training in this field (most commonly surgical critical care) and specialty certification surgical critical care. 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 stabilize such patients, such as thoracostomy,cricothyroidotomy, compartment fasciotomies and emergencylaparotomy orthoracotomy tostanch bleeding. They are also called upon to staff surgical intensive care units or trauma intensive care units.[citation needed]
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. Infections and rupture of theappendix and small bowel obstructions are other common emergencies.
This is a relatively new specialty dealing withminimal access techniques using cameras and small instruments inserted through 3- to 15-mm incisions.Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are also able to be repaired laparoscopically.Bariatric surgery can be performed laparoscopically and there are benefits of doing so to reduce wound complications inobese patients. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.
General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases (such asulcerative colitis orCrohn's disease),diverticulitis, colon and rectal cancer, gastrointestinal bleeding and hemorrhoids.
General surgeons can specialise in Upper Gastro-intestinal (orforegut) surgery, which includes the surgical treatment of diseases of thestomach andoesophagus,liver,pancreas andgallbladder.[2] In the UK, Upper GI surgeons can subspecialise further as benign surgeons, dealing withhiatus hernias and gallbladder diseases, bariatric surgeons, providing surgical care forweight management and metabolic diseases, or oesophago-gastric surgeons, dealing with complex problems related to the upper gastrointestinal tract (the foregut), including cancer. Surgical care of complex liver and pancreatic problems (includingliver cancer andpancreatic cancer) is undertaken byHepatobiliary and Pancreatic Surgery sub-specialists.
General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy tomastectomy, especially pertaining to the evaluation, diagnosis and treatment ofbreast cancer.
General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are typically performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.
General surgeons are trained to remove all or part of the thyroid andparathyroid glands in the neck and theadrenal glands just above eachkidney 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.
Responsible for all aspects of pre-operative, operative, and post-operative care of abdominal organ transplant patients. Transplanted organs include liver, kidney, pancreas, and more rarely small bowel.
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Surgical oncologist refers to a general surgical oncologist (a specialty of a general surgeon), but thoracic surgical oncologists, gynecologist and so forth can all be considered surgeons who specialize in treating cancer patients. The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume (i.e., the more cancer cases a surgeon treats, the more proficient they become, and their patients experience improved survival rates as a result). This is another controversial point, but it is generally accepted, even as common sense, that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such aspancreaticoduodenectomy for pancreatic cancer, andgastrectomy with extended (D2) lymphadenectomy for gastric cancer. Surgical oncology is generally a 2-year fellowship following completion of a general surgery residency (5–7 years).
Most cardiothoracic surgeons in the U.S. (D.O. or M.D.) first complete a general surgery residency (typically 5–7 years), followed by a cardiothoracic surgery fellowship (typically 2–3 years). However, new programmes are currently offering cardiothoracic surgery as a residency (6–8 years).
Pediatric surgery is a subspecialty of general surgery. Pediatric surgeons do surgery on patients under age 18. Pediatric surgery is 5–7 years of residency and a 2–3 year fellowship.
In the 2000s,minimally invasive surgery became more prevalent. Considerable enthusiasm has been built aroundrobot-assisted surgery (also known asrobotic surgery), despite a lack of data suggesting it has significant benefits that justify its cost.[3]
In Canada, Australia, New Zealand, and the United States general surgery is a five to seven yearresidency and follows completion ofmedical school, eitherMD, MBBS, MBChB, orDO degrees. In Australia and New Zealand, a residency leads to eligibility for Fellowship of theRoyal Australasian College of Surgeons. In Canada, residency leads to eligibility for certification by and Fellowship of theRoyal 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 theAmerican Board of Surgery or theAmerican Osteopathic 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 theUnited Kingdom, surgical trainees may apply to enter training after five years of medical school and two years of theFoundation Programme. During the two year core surgical training programme ("phase 1"), doctors are required to sit the Membership of theRoyal College of Surgeons (MRCS) examination. On award of the MRCS by one of the four surgical colleges, surgeons may hold the title 'Mister' or 'Miss/Ms./Mrs' rather than doctor. This tradition dates back hundreds of years in the United Kingdom from when only physicians attended medical school and surgeons did not, but were rather associated withbarbers in theBarber Surgeon's Guild. The tradition is also present in manyCommonwealth countries includingNew Zealand and some states ofAustralia. After completion of phase 1 training, trainees may apply for a nationally awarded Higher Surgical Training (HST) programme, which lasts six years and is now divided into two further phases (phases 2 and 3). Trainees are expected to declare a sub-specialty before the end of phase 2, and training during phase 3 focuses on that sub-specialty. Before the end of HST, the examination forFellowship of the Royal College of Surgeons (FRCS) must be taken in general surgery plus the subspeciality. Upon completion of training, the surgeon will be eligible for entry on theGMC Specialist Register. They may then apply to work both in theNHS and independent sector as a consultant surgeon, although many trainees complete further fellowships.[4] The implementation of the European Working Time Directive limited UK surgical residents to an average 48-hour working week.[5]
In India general surgery is a 3 yearpostgraduate medical degree referred asMS (General Surgery) and often is the foundation course for further super-specialisation such asNeurosurgery,Cardiothoracic surgery,plastic surgery, etc.[6][7] In India qualified physicians may apply for the course after successful completion ofMBBS from aNMC recognised institution, one year of mandatory internship and rural service bond (if any). The candidates applying for general surgery must clear forNEET (PG) or AIIMS INI-CET (for admission ininstitutions of national importance) and are granted admission on the basis of merit andreservation.[8][9]
