Operate sitting down

[Serve Others]

Hey guys,

First I would truly appreciate it if you guys would not to write me off about my question because this is my first post or because I am admittedly telling you I haven't gotten into med school yet. A little background: finished my undergrad in the honors college (microbiology), I worked in a research lab for two years in drug discovery, I am published in the journal of biotechnology, and I share a patent with two other doctors. After college I taught science and coached the soccer team for the school. Last year I quit my job to do full time missionary work for 9 months and in doing so/through this experience with some soul searching I realized that I wanted to not necessarily change the world but do as much as I can to be a change in the world. I noticed in the past what stopped me from going into medical school was fear, fear of missing out and "wasting" my life away.... so eventually I lost purpose. Thankfully I now know what I want from life now.

So here is the deal: I am really interested in becoming a general surgeon or orthopedic surgeon. My only problem (besides all the hurdles I will have to go through to make it there) is that ever since I could remember I've had a bad back. It is very hard for me to stay standing up for long periods of time. I would say anything above 30min is already causing noticeable ache/pain in my lower back, while I can very well run/jog for the same amount of time with barely any pain. Besides treating it: better posture, losing weight, appropriate shoes, strengthening core, working out/staying fit, stretching, pain medication, distributing weight between feet at different time intervals, etc. if all that fails, is it realistic to say that I could foresee operating while sitting down? I am honestly not interested at all in ENT or urulogy or any other surgical realm, but really only general and orthopedic surgery.

I am currently thinking orthopedic surgery could work. I watched an acl repair (from youtube: ) in which the surgeon was sitting down. To me, the angle in which you can operate certain bone extremities seems feasible when sitting down, perhaps at least during some part of the operation. Intuitively to me this wouldn't seem possible for general surgery because surgeries requiere more visual depth in this field, unless you are using some robotics.

I realize this might be a whole different animal during residency if I match, so I guess my thoughts are:
- Initially during residency I'll have to figure out a way to stand up without bodily collapsing and then eventually with time and practice the attending and other residents might be willing to allow me to do certain cases sitting down so long I demonstrate proficiency?
- If I am being naive, then will there be a good chance post residence I could tailor my practice setting wether private, hospital or academics to be able to do this?
- Any other thoughts?

Truth is I am willing to work very hard and sacrifice, but I am not willing to live in perpetual lower back pain that lands me in the OR to be operated ironically by a surgeon sitting on a stool. lol. Moderator please don't move my thread to pre-med as I feel I would not get real experience advice from there. Thank you all in advance for your time and feedback.

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[Handinhand]

You sit down for a majority of hand surgeries -- more standing if you decide to do more shoulder/elbow in your practice. Foot & Ankle seems to sit down for a fair amount of their surgeries. You will have to get through a 5 year orthopedic surgery residency however to get into those fields, and there is almost no sitting in trauma, joint, sports, tumor, & spine.

Do you have a physical deformity or cause to your back pain? If not, you might just not be used to standing for so long, and your back and leg musculature need to get "used to" supporting you standing for such long periods of time. I know when I started my sub-i's I would come home and it would feel like someone hit me in my lumbar spine with a baseball bat; however, after 3-4 months of ortho my back was fine.

Compression socks + good shoes (birkenstock clogs) did wonders for my foot pain, lower extremity swelling, and back pain during the especially long days (peds spine -- pedicle screws everywhere!)

 

[massmocha]

What have you tried to do standing for prolonged periods before? You may find that if you're doing surgery and interested in the case time goes by quickly and you don't notice the back pain. Also, even though standing your hands are usually on the operative field/patient and may offload some weight.

 

[Serve Others]

You sit down for a majority of hand surgeries -- more standing if you decide to do more shoulder/elbow in your practice. Foot & Ankle seems to sit down for a fair amount of their surgeries. You will have to get through a 5 year orthopedic surgery residency however to get into those fields, and there is almost no sitting in trauma, joint, sports, tumor, & spine.

Do you have a physical deformity or cause to your back pain? If not, you might just not be used to standing for so long, and your back and leg musculature need to get "used to" supporting you standing for such long periods of time. I know when I started my sub-i's I would come home and it would feel like someone hit me in my lumbar spine with a baseball bat; however, after 3-4 months of ortho my back was fine.

Compression socks + good shoes (birkenstock clogs) did wonders for my foot pain, lower extremity swelling, and back pain during the especially long days (peds spine -- pedicle screws everywhere!)

Thanks for the reply Diggidy. On average how long were the cases in the OR during residency? What type of cases were you allowed to (if at all) to sit down on?

 

[Serve Others]

What have you tried to do standing for prolonged periods before? You may find that if you're doing surgery and interested in the case time goes by quickly and you don't notice the back pain. Also, even though standing your hands are usually on the operative field/patient and may offload some weight.

Thanks for the reply massmocha. Pretty much anything, from amusement parks, yard work, festivals, coaching, having a conversation, etc. and shadowed as well. I remember shadowing an orthopedic oncologist, a hip replacement needed due to cancer.... 3 hours in and I was dying, couldn't figure out how to get out of the OR without embarrassing myself...

Never really had the chance to offload some weight on the patient though..

 

[Serve Others]

Any other thoughts? What is realistic for me? As far as I know I don't have a physical deformity is just the anatomy of my body (my uniqueness, haha)

What about general surgery? Any thoughts there?

 

[bashwell]

Just ask anesthesia to adjust the bed for you.

On a more serious note, nevermind standing or sitting in the OR, surgeons (especially general surgeons) are often very busy, running back and forth between the clinic and the wards and OR, or elsewhere around the hospital, and in the clinic or wards you may have to do physical exams on patients, etc. Surgery (especially general surgery) is often a very "physical" job.

If you like the OR and surgery, and want to have more sitting time, just remember the ABCs of anesthesia -- airway, book, chair.

 

[FootAndAnkle]

You could consider podiatry, as well. Like Diggidy noted, the hand, foot, and ankle are fairly amenable to remaining seated, but hand would require going through ortho or general surgery first. Pretty much all forefoot surgeries can be accomplished sitting down, and you could certainly arrange for at least some periods of sitting during most rearfoot and ankle cases. One podiatrist that I operated with pretty much stayed seated exclusively, so I'm sure you could tailor the same scenario for yourself once out of residency (though I'd say most like to stand for procedures other than those involving a plantar approach). Additionally, training is shorter and exposure to specialties with longer cases on average would perhaps be limited enough for your tolerance.

 

[OrthoTraumaMD]

I would stay away from Ortho and General. Even hand surgeons have to stand, and the other parts of our job require standing. Ortho residency is 5 years and during that time you will be doing all kinds of cases, some lasting 8 hours or more. You'll see what we mean when you do Med school rotations. But one surgical field you could consider is ophthalmology. I think most of their work is done while sitting.