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What about NeuroIR aka Endovascular Surgical Neuroradiology aka Neurointerventional surgery?
No big openings, but extremely complex cases, which require a lot of fine motor skills, actually more so than most surgical subspecialties i had the pleasure of scrubbing in on. They share patients with Nsurg and their tend to also be very sick. Risk of these "procedures" are not minimal given that you "operating" within a patient's brain or spinal column.
Sorta like interventional cardiology in a way... they do amazing things, for example removing a clot in patient with LVO (stroke), while also alleviating the cardiac load on a patient with vein of Galen Malformation...both of which can mean near sudden death if a NIR does not intervene. What about intracranial tumor embolization, AVM/dAVF repair, or intra-orbital approach to repairing a Cavernous-carotid-fistula (CCF), epitaxis bleeding repair, or simply fixation of a complex venolymphatoc malformation? These "procedures" require highly complex skills for which the patients are placed under general anesthesia for hours, like any other "surgery".
As someone mentioned in a post above, most endovascular Neurosurgeons do exact same thing as NIRs.... but NIRs dont have the luxury of opening the skull when **** hits the fan - have to consult nsurg...so i see it from that perspective.
Most consults to IR or NIR come from surgeons, who know there is a safer way to treating a specific disease instead of big whacks at the patients skin.
Most surgical subspecialties are becoming minimally invasive at an exponential rate and this trend will continue as far as I can see. We keep finding ways to treat patients without the morbity of open surgeries. Some cases will always require open surgery, but those numbers continue to shrink. Hence, in the he future i guess we will all be interventionalist. Hehe.
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This is an interesting discussion, where its easy to lose track at the grey areas.
This is the definition of the word surgery by the AMA:
Surgery is performed for the purpose of structurally altering the human body by the incision or destruction of tissues and is part of the practice of medicine. Surgery also is the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition of live human tissue which include lasers, ultrasound, ionizing radiation, scalpels, probes, and needles. The tissue can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reductions for major dislocations or fractures, or otherwise altered by mechanical, thermal, light-based, electromagnetic, or chemical means. Injection of diagnostic or therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central nervous system also is considered to be surgery (this does not include the administration by nursing personnel of some injections, subcutaneous, intramuscular, and intravenous, when ordered by a physician). All of these surgical procedures are invasive, including those that are performed with lasers, and the risks of any surgical procedure are not eliminated by using a light knife or laser in place of a metal knife, or scalpel.
This is the definition by the cambridge dictionary
Interesting enough the mw dictionary doesnt make that clear distinction of cutting open the body
I dont think the complexity of a procedure matters in terms of defining what is surgery and what isnt . And i also dont think that just because some surgeons perform a procedure i.e NIR, that it makes that procedure into surgery.
The ama would have you believe that any person doing a steroid shot is a surgeon.
This is the definition of the word surgery by the AMA:
Surgery is performed for the purpose of structurally altering the human body by the incision or destruction of tissues and is part of the practice of medicine. Surgery also is the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition of live human tissue which include lasers, ultrasound, ionizing radiation, scalpels, probes, and needles. The tissue can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reductions for major dislocations or fractures, or otherwise altered by mechanical, thermal, light-based, electromagnetic, or chemical means. Injection of diagnostic or therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central nervous system also is considered to be surgery (this does not include the administration by nursing personnel of some injections, subcutaneous, intramuscular, and intravenous, when ordered by a physician). All of these surgical procedures are invasive, including those that are performed with lasers, and the risks of any surgical procedure are not eliminated by using a light knife or laser in place of a metal knife, or scalpel.
This is the definition by the cambridge dictionary
Interesting enough the mw dictionary doesnt make that clear distinction of cutting open the body
I dont think the complexity of a procedure matters in terms of defining what is surgery and what isnt . And i also dont think that just because some surgeons perform a procedure i.e NIR, that it makes that procedure into surgery.
The ama would have you believe that any person doing a steroid shot is a surgeon.
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I mean... I dont know how you wouldnt consider an ophthalmologist who operates a surgeon, but to each their own I guess. Would you call cataract surgery or a retinal detachment repair an "interventionalist" procedure?
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What about a diamond blade scalpel into the cornea or sclera?
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Semantics? I'll make sure you get signed up with an optometrist with no residency training for your cataract or glaucoma surgery instead of a residency trained ophthalmologist lol.
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This being said, the lifestyle freedom is why many dont make as much. If you want to be a busy cataract surgeon, especially now that we offer many cash pay upgrades with refractive technology then you can really make much more. And its more busy/stressful but still pales in comparison to some other specialties.
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Whatever someone said about ego is honestly probably a big part of it for many, but personally I really could care less of what other doctors think outside of the specialists I actively interact with. I'll just sit over here in my corner making bank doing my non-surgical procedures, while working 36 hours a week and livin' the dream!! 
Tell that to the Endovascular Neurosurgeon who essentially practices entirely endovascular procedures. Both he and his patients are under the impression that they are under going surgery - which sorta makes sense due to the inherent risks, being under general anesthesia and the complexities of the procedure.
I especially like this quote you had "Surgery also is the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition transposition of live human tissue which include lasers, ultrasound, ionizing radiation, scalpels, probes, and needles".
As i said earlier, almost all surgeons will be interventionalists in yrs to come...it really make no sense damaging normal tissue to get to pathology, if u dont have to. You want to get in there like a Ninja or Sniper, whatever u prefer to fix the structural abnormality.
I actually prefer interventionalists...just to delineate the field from surgery in a traditional sense. NIR is a really cool field, if you like new tools/treatment modalities/technology, while treating the most complex cases; it also preserves the aspect of medicine where u can empathize with really sick patients and their families.
Ego is a definitely a thing, but the Neurosurgeons I have worked with have been pretty dudes and dudettes.
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You should ask the neurosurgeon doing the NIR if they consider the procedure surgery or an intervention/procudure. I bet many would call it a procedure. I have yet to meet a neurosurgeon who just does NIR, considering those procedures cant necessarily be scheduled in advance and they still keep spine to pay the bills on the OR schedule.
I agree with you that the lines would be blurring going forward. I am literally giving you the definitions. You cant be a surgeon if you havent done and trained for doing surgery. Now if the a surgeon does procedures as well that doesnt mean those proedures become surgery, its not like the NIR procedures are going on in the OR either.
That part you are bolding would mean a steroid injections is surgery.
Nice chatting...but we are beating a dead-horse at this point.
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Honestly kind of agree with this sentiment. General Ophtho doesn't give off the surgeon vibe (unless maybe if the pgy-1 yr was in Gen surg but still not really since the remainder of the residency doesn't feel like a surgical residency) Oculoplastics ppl are def surgeons. Mohs? not rlly to be honest lol.
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They're proceduralists, not surgeons
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They are not surgeons. It's a weird question because I don't know of any docs in those fields who consider themselves surgeons.
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Yeah I dont understand why people think that other people care. An optho friend of mine thinks hes a surgeon. Hes not but that's fine, optho is optho and thats okay haha
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Not sure I’d want anyone but a urologist repairing my ureters. Doesn’t make the general surgeon who snipped them any less of a surgeon.
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If someone is cutting open part of my eye, they’re a surgeon to me. Is an ent that doesn’t do h&n a surgeon?
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Lines are blurring for sure. Structural interventional cardiology is taking over a lot of previously surgical cases. TAVR, watchman, TMVR, mitraclip, etc are taking and will continue to take a lot of volume away from cardiac surgeons just like the interventionists decimated CABG volume.
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Like if they just do T & A or not even that?
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Give you friend back his H dammit. OpHtho. And they are surgeons generally speaking. They train on eye surgery even if they end up not doing many.
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They still trained to do surgery though. A head and neck surgeon of mine talked about how the backlog of hernias was so bad at the VA associated with their program that before you could book your specialty case you had to do a hernia repair too.
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I was being facetious but that’s absurd. ENT is doing inguinal hernia repairs? Seriously??
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Meh. I have nothing but respect for the IR guys here at my institution. Anything I do endo and outpatient is just that - a minimally invasive procedure. What I find interesting is that I chose my fellowship because of how much open surgery we do here. Over the course of my training I have become much more endo first. Mostly because I've realized that big whacks when they go bad or fail down the road, require another big whack; except going through redo or three-do planes is just not that enjoyable. Often times I'm thinking **** like, "Dafuq did I just cut right there?" or "Am I ex-arterectomizing the vessel?" or "Dafuq am I doing here right now?" or "I should've been a f**king gym teacher." The important thing about VS is the careful thought into the first procedure because that'll dictate everything else that happens afterwards since nothing we do lasts forever. My next lecture will be titled, "How to Plan for Failure: My Career in Vascular Surgery." Cheers.
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Yes.
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So this guy said a lot of outlandish **** to me but with a face that conveyed sincerity. He talked about how they would do succinylcholine races too (like who could get the farthest before falling down and needing to be bagged) and try the cinnamon challenge. There was you tube video of the cinnamon one apparently. So I hesitantly believe him. Sounds like some BS the VA would pull to make their numbers better.
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Your ignorance is showing. I’m starting to think you’ve never stepped in an ophtho OR before. An endoscopic DCR has CSF leak and death as a known risk. Not to mention orbital decompression where you often expose dura.
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It was ironic commentary on this thread not meant to be taken literally.
I’ve been working in ophtho OR’s since 1993 with many different ophthalmologists, some good and some bad. And that’s a terrible surgeon if they get that lost. It’s like the general surgeon I know who accidentally removed a uterus. The pathologist actually came to the operating room which is rare. He said, “The good news is that it’s not a tumor. The bad news is that it’s the uterus.” Sadly one of many OR misadventures with the guy. Who the f*** actually cares in real life who’s a surgeon and who’s not?
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lost in translation I guess. It's not so crazy. You do the same surgery 10000 times and you are bound to have complications...- Joined
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I don’t care how many times you’re doing an abdominal surgery, you shouldn’t be pulling out the uterus by accident.
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Easy to say that based on seeing normal or relatively normal internal abdominal anatomy. But I am picturing a scenario where there are adhesions everywhere and everything is hard due to inflammation versus cancer and an abnormally shaped uterus that makes it so you can't actually see down in the pelvis to figure things out by landmarks. Add in the possibility someone said they had a hysterectomy in the past but whoever did it only did a partial and I can see it happening. I got called in once because gyn went back in after a hysterectomy because of persistent "hematoma" which turned out to be something mass like with some bowel adhesions they wanted my opinion on. I took a look and said I don't know what the **** all that is but let me call the gyn oncologist to see if he has an idea. He came and scrubbed in which meant I didn't have to so I left. Turns out that was the rest of the very abnormal uterus. Someone bolder than me might have separated it from the bowel and removed it, maybe not realizing it was a uterus.
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Exactly. Even the "simplest" procedures can be humbling (suddenly, catastrophically, pit-of-your stomach humbling)
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I don't fault the ones who don't know this unless they are actually in the field. Those people are dangerous. The others are just naive.