In Part II of this book, we will discuss the various specialties and each major procedure in more detail. At this time I just want to familiarize you with the main fields of surgery and outline for you the types of procedures they do.
First is general surgery, my own specialty. At one time, about a hundred years ago, this encompassed all the areas of surgery, and the general surgeon could handle all surgical procedures, including the chest, heart, orthopedics, and pediatrics. Over the years each specialty has advanced to the point where one individual cannot have an expertise in all areas, and young surgeons have learned to choose which area is most interesting for them.
General Surgery encompasses Abdominal Surgery (stomach, intestines, colon, appendix and rectum, pancreas, liver, spleen, gallbladder, and adhesions), skin, breast, thyroid, parathyroid, hemorrhoids, pilonidal disease, esophagus, hernias in the abdomen, abscesses, “Lumps and Bumps,” and a diverse selection of cancers throughout the body. Although this is not a complete list, it includes most of the procedures which the practicing general surgeon does today. For this he is usually required to take an internship for one year and four to six years of residency training. In some programs, such as the one I went through, the resident does research in an area of his interest and may write a thesis and get a Masters of Science in Surgery Degree.
The second area I want to address is Peripheral Vascular Surgery. This usually requires a surgeon to take an additional one to two years of training after the general surgical residency, although some comprehensive programs combine the general and vascular surgery in one training program. Vascular surgery includes suturing, repairing or replacing the major blood vessels of the body, such as the aorta in the chest and abdomen down to the smallest one-millimeter vessels in the hands and feet which can be approached surgically. In the arms and legs, the arteries are considered medium-sized and are much more amenable to repair than the tiny vessels of the hands and feet. Vascular surgeons are the ones who sew arteries and veins together for use during dialysis for kidney failure, and place all kinds of artificial shunts and bypasses, either to get around blocked vessels or for dialysis access, as we will explain in a later chapter. This specialty also corrects problems of the carotid artery (which supplies blood to the brain narrowing may cause a stroke), renal (kidney) arteries narrowing of which may cause hypertension (high blood pressure), and vein problems (varicose veins and venous ulcers). The most recent advances in vascular procedures are in the field of endovascular surgery, where a trained specialist can repair an artery using balloons and special devices placed in the damaged arteries through tiny incisions, obviating the need for major vascular surgery.
Urology is the surgical sub-specialty which includes kidney, ureters, bladder, prostate, testicles and internal and external genitalia. In this field we have the kidney, ureteral and bladder stones, prostate enlargement, and various types of cancers specific to this area.
Orthopedics (which literally means “straighten the child”) is the medical and surgical treatment of bones and joints, including the spine (which is shared with the neurosurgeons) and all types of trauma involving the bones and joints. These surgeons handle back pain and joint pain, amputations, and endoscopic surgery on the joints. Some orthopedists go on to further specialize in complex back and spinal surgery or hand surgery, including procedures which require microsurgery (using special magnifying lenses to repair tiny vessels in the hand). A whole field of re-implantation surgery has developed for severed limbs, which requires further expertise and training.
Gynecological surgery centers on the female reproductive organs, the vagina, cervix, uterus, tubes, and ovaries, including hysterectomy (removal of the uterus), salpingectomy (removal of the fallopian tubes) and oophorectomy (removal of the ovary). These surgeons also may do diagnostic or therapeutic laparoscopy (using a small incision and placing a small camera in the abdomen to avoid large incisions), such as tubal ligation or identification of pelvic infections or other problems. A whole advanced field of Gynecologic Oncology has developed requiring two to four additional years of training to learn how to remove all cancers involving female organs.
Next we move on to Neurosurgery, the specialty focusing on diseases involving the brain, spinal cord and nerves. It requires two years of additional training after the general surgery residency, and the neurosurgeon must be well versed in the diagnostic abilities of a neurologist to identify the problems in brain function. We will go much more into detail about neurosurgery in later chapters.
Thoracic surgeons, not surprisingly, operate on the thorax or chest cavity, which includes the esophagus, lungs, ribs, and chest wall. They remove lung cancer and other tumors, benign and malignant, and do surgical procedures for infections in the chest, called empyemas and lung collapse secondary to trauma or emphysema (a disease where the lungs contain abnormal air pockets that may rupture).
The Cardiac surgeons operate on the heart, replacing diseased heart valves and bypassing coronary arteries (the blood vessels that supply the heart itself). They also may surgically correct congenital deformities, although pediatric (children) heart surgery is a sub-specialty all its own. Cardiac surgeons usually require a two-year fellowship in addition to the regular surgery residency.
Plastic and Reconstructive surgeons take several years training in their specialty to do cosmetic surgical procedures, such as breast augmentation and reduction, facial plastic procedures (face lift, brow lifts, rhinoplasty [nose job], and acid and laser skin peels), liposuction, and abdominoplasty. They also do reconstructive surgery after trauma, congenital defects, breast reconstruction after mastectomy, and complex skin grafts and “flap” procedures, which I will explain later and which include Tram flaps, Pedicle flaps and Rotation flaps.
The Ophthalmologists, in addition to the medical management and examination of the eyes, also perform the delicate and often complex procedures including cataracts, retinal and eye muscle surgery, trauma, and the new laser and LASIK procedures.
The Otorhinolaryngologists must learn to pronounce their specialty first and then learn how to take care of problems involving the ears, nose and throat, including sinuses, parotid gland, tongue, tonsils and adenoids, and facial nerve, and have special training in removing cancers in this area.
Pediatric surgery emphasizes that children are not just little adults, but people with special problems all their own. They have a host of congenital deformities, as well as the usual problems of hernia and appendicitis, and these specialists are specially trained to handle the delicate management of tiny infants.
In Part II of this book we will discuss these surgical specialties and their procedures including the diagnostics, anatomy, techniques, and complications.
Chapter 5
THE SURGEON'S OFFICE
My surgeon has an office on the ocean in a barge.
The place is kinda dirty, the reception room is large.
He doesn't have a license, but he has a lot of saline,
He says it's from the ocean, he collects it when he’s whaling.
He's not too highly skilled, and his hands are quite a fright,
But hey, you can't have everything, and wow...his price is right!
When I asked my office manager to list what she considered most important about an office, she gave the following comments. First, she stressed location, and that included parking. If you're sick and not feeling well or if you've had surgery, you don't want to have to travel a long way to see your doctor and then not be able to find parking. Simple but important!
Next, when you walk into someone's home, one glance will give you a good idea as to whether the person is well organized or not. Similarly, when you walk into an office you should get a feeling of professional organization, with decent lighting, seating, and tasteful decorations. If the doctor and his staff don't care enough to take an interest in the details of his office, it may reflect on how he will take care of you! The office should be clean and orderly. Now,