What do you think is the most technically difficult surgical specialty/subspecialty?

[WildcatMD]

Based on what people here have seen, what surgical specialty/subspecialty do you think is the most technically difficult (ie has the hardest procedures to perform successfully)?

I realize that this isn't a fact obviously and that everybody has their own opinions, but I'm still curious to get people's thoughts on this.

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[droliver]

Based on what people here have seen, what surgical specialty/subspecialty do you think is the most technically difficult (ie has the hardest procedures to perform successfully)?

I realize that this isn't a fact obviously and that everybody has their own opinions, but I'm still curious to get people's thoughts on this.

My money's on off-pump CABG anastamosis & digital vein anastamoses during digit replants. The first is a moving target with little margin for area. The second is a stationary field but the tissue you're working with is very,very fragile & unforgiving

 

[johnny_blaze]

my opinion = high risk vascular surgery.

Haemorrhages can be difficult to control and it doesn't matter how many suckers and sponges you have, your view wont be good. Plus the fact that the guy is actually bleeding to death on your table can be quite stressful and can really affect performance.

tough cases that come to mind...
- intra abdominal RAAA with a vena cava fistula... sooo much blood.
- infected fem-fem crossover graft resulting in anastomotic breakdown and wound dehiscence... absolute nightmare

 

[Misterioso]

Pediatric heart surgery, especially on neonates, trumps them all--or so I've been told.

Tons of possible variations on many different disorders, not to mention you often don't know exactly what you're going to encounter until you open the chest. Got to be able to think fast and strategize on the fly. Plus you are operating on a heart the size of a walnut so you need to have sharp technical skills. Probably why so few go into it.

 

[njbmd]

Based on what people here have seen, what surgical specialty/subspecialty do you think is the most technically difficult (ie has the hardest procedures to perform successfully)?

I realize that this isn't a fact obviously and that everybody has their own opinions, but I'm still curious to get people's thoughts on this.

Hi there,
I believe that overall, Pediatric surgery is the most technically difficult because of the wide breadth of procedures that you have to master in a two-year fellowship. While operating on the beating heart can be a challenge, some of the pediatric cases, like liver resections on very small kids can be very difficult.

njbmd

 

[DrRobert]

I'm not going into surgery but many attendings have alluded that radical neck dissections in ENT and orthopedic hand surgery are the most intricate surgeries and require great knowledge and skill in manipulating the microanatomy.

 

[davvid2700]

biliary surgery
Liver transplant
pancreatic surgery

eye surgery

 

[Blade28]

I agree with pediatric surgery - and some of those cases, like those for congenital heart disease, horrendous NEC, or liver/biliary malformations, can be absolute nightmares.

 

[TheThroat]

I'm not going into surgery but many attendings have alluded that radical neck dissections in ENT and orthopedic hand surgery are the most intricate surgeries and require great knowledge and skill in manipulating the microanatomy.

Nah, bid neck wacks are no big deal. The hardest ENT surgery is, IMO, skull base microsurgery (acoustic neuromas) and the microvascular work done on free flaps. For the general otolaryngologist, the hardest surgeries I have done are in middle ear work. Try putting a 0.6 mm by 4.25 mm stapes prosthesis in a 0.7 mm hole in the stapes footplate.

 

[DrRobert]

Nah, bid neck wacks are no big deal. The hardest ENT surgery is, IMO, skull base microsurgery (acoustic neuromas) and the microvascular work done on free flaps. For the general otolaryngologist, the hardest surgeries I have done are in middle ear work. Try putting a 0.6 mm by 4.25 mm stapes prosthesis in a 0.7 mm hole in the stapes footplate.

Of course, I will defer to the surgeons on all of these discussions. I have heard hand surgery come up the most though. Not sure if they are referring to digit replacement, crush injuries, or all hand surgery in general.