General Surgeons and Gyn procedures.

[Leukocyte]

I have only seen one case at our program where a General Surgeon did a TAH/BSO in a 54 yo. It was not planned, but he did it as part of a peritonitis case after he felt that the uterus and the adnexa had to come out (Although I was scrubed in, I do not remember the details of the case since I was a cluless/bored MS-3 at that time). I do remember that she was very pissed about this when I pre-rounded on her on POD#1. I also remember that this surgeon was suspended some time after the surgery, but I do not know the reason for his suspension or if it has anything to do with that patient.

My question is:

Do General Surgeons perform Gyn procedures (ex. TAH/BSO, Ovarian Cysts....)?

If so how commonly?

What about in trauma cases? Does/can a trauma surgeon handle surgical gyn issues, or does he/she consult with Ob/Gyn to take care of the gyn part - For Example, a trauma that involves the internal genitalia in a 21 year old female.

Thank You. 🙂

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[Winged Scapula]

My question is:

Do General Surgeons perform Gyn procedures (ex. TAH/BSO, Ovarian Cysts....)?

They can if they have hospital privileges to do so or find that the procedure is necessary for the patient's health (ie, while doing another abdominal procedure).

If so how commonly?

Uncommonly. In a hospital setting most would consult Gyne if there was a question about the viability of the adnexae. Some Gen Surg residencies do have a Gyne rotation so I would imagine those residents would be more comfortable than those of us who haven't done any since 3rd year medical school.

What about in trauma cases? Does/can a trauma surgeon handle surgical gyn issues, or does he/she consult with Ob/Gyn to take care of the gyn part - For Example, a trauma that involves the internal genitalia in a 21 year old female.

Thank You. 🙂

Again depends on hospital privileges, surgeon comfort and training with the procedure and availability of Gyne consultation. In my 4 years as a resident, I've never seen a Gyne procedure such as you list being done by a General Surgeon; the most I've seen is a mass sent off which appeared to be an endometrial implant on the colon (it was). If a trauma patient suffered major damage to the adnexae, I'm sure a Trauma surgeon would be able to handle the damage control, but again many would seek Gyne consultation especially in a young woman with her childbearing years ahead of her (presuming the organs appeared to be viable).

 

[logos]

I worked in the OR in my small (~50k) hometown for awhile...

We had an issue a couple years ago where a gen surgeon did a hyster without contacting the obgyn on call. Similar situation, had no idea it would be a gyn problem going into it. This was not a big deal because the gen surgeon couldnt do it, but because of the $ involved. At least at home, it is polite to call the obgyn on call and ask if he wants to come in and do it. If he dosent want to do it, then the gen surgeon can do it without taking any heat from the obgyns.

 

[Leukocyte]

Thanks Kimberli! 🙂

 

[JudoKing01]

It's not exactly a hyster, but I've worked with gen surgeons that have removed ovaries and tubes during bowel cases...one case we removed a section of small bowel, a diverticulum, an appendix, and an ovary/tube all on the same patient.

 

[Celiac Plexus]

taking out the uterus, and ovaries without consent is generally not standard of care. in fact, even with the discovery of omental mets, in say a 60 year old, one would not perform TAH/BSO without consent. one would close, get consent, and then take the patient back to the or a few days later for the TAH/BSO, omentectomy, etc....

the exception to this i would imagine is that this case is a trauma case, and the surgeon determined that the uterus was a cause of the peritonitis, and in that case, closing and getting consent would be potentially life-threatening to the patient. he/she probably decided to take the uterus/ovaries for that reason. still, i can imagine that the patient was not thrilled about losing her repro organs when she was not expecting to. this is where good bedside manner is critical.

as far as general surgeons doing gyn work... it happens more in the rural setting where access to an ob/gyn may be lacking. but i agree that if an ob/gyn is available, it is good form to call him/her and get him/her on board.

 

[JudoKing01]

Yeah this definately wasn't consented for. Now that I think about it a little more, she might have had a Hx of a hyster, no BSO (obviously). I think we took some omentum and the ovary/tube.

 

[Espion]

I've seen more often where gyn consults general surgery for cases that are more complicated to open and close. I think that probably goes more with their personal level of experience, though.

i.e. One gyn-onc patient incidentally had two umbilical hernias (a hernia within a hernia). Rather than tackle the hernias themselves, gyn consulted general surgery to open and close the case. They had a lot of fun ribbing each other mercilessly. The patient ended up having two watermelon sized (no lie) totally benign cysts excised. Although general surgery is the life for me, it was fun to see the general surgeon's eyes get as big as dinner plates as they watched the ob-gyns excise the masses. They definitely weren't familiar with the large world of dermoid cysts. heh

 

[Leukocyte]

I have also seen a case were General Surgery was consulted by Orthopaedic surgery to open and close a case that involved severe kyphosis in a 16 year old female.

I have never seen Orthopaedics consult GS to open before. 😱

 

[surg]

As a GS res. I have performed ~4 TAH/BSO and an assortment of other minor gyn procedures (e.g. Dx. Lap, tubal ligation, oopherectomy) because we cover Gyn for the VA (with a Gyn attending). However, that certainly doesn't mean that I would plan to do it in practice. While they aren't difficult procedures from a technical standpoint by and large, it isn't an area that I keep up to date on the literature. Thus, while if pressed (e.g. in a trauma situation or one where no GYN was avail) I could get it done, I would not ever hold myself out as someone who should be consulted for those procedures.

As far as Ortho c/s GS, that happens every week here as we do most of the anterior spine exposures for the Ortho Spine guys (and even occasionally for the neurosurg spine people). We do the opening, move all the intervening organs out of the way, isolate all the vessels that could be injured, then hang out while they do the ortho part and step in if they nick a vessel. Then we get to close and for thoracic spine cases leave in the chest tubes. Post-op we manage their ileus and Chest tubes as consultants. Not exactly a rocket science, but since they don't want to do it, we have to.

 

[Winged Scapula]

I have also seen a case were General Surgery was consulted by Orthopaedic surgery to open and close a case that involved severe kyphosis in a 16 year old female.

I have never seen Orthopaedics consult GS to open before. 😱

Like surg notes, really not uncommon. Our Peds surgeons do most of the exposures as the procedures are generally on children. We do them pretty frequently here as well.

Frankly, its a procedure one might want to get good at...I understand the reimbursement for it can be a nice chunk of change.

 

[Justin4563]

a general surgeon doing a hysterectomy should be malpractice.... Similarly, a gynecologist.. taking out the appendix should be equally frowned upon..... stay on your own turf...

 

[Smurfette]

a general surgeon doing a hysterectomy should be malpractice.... Similarly, a gynecologist.. taking out the appendix should be equally frowned upon..... stay on your own turf...

It's not malpractice for a gen surgeon to do a hysterectomy. Many older generation surgeons (and still many community surgery programs today) had a Gyn rotation or two during residency. In smaller communities, which often have FPs instead of ob/gyns, gen surgeons do c-sections as well. The number of gen surgeons who do this is dwindling, but they're still out there. And IMO if you can do a c-section, you damn well better know how to do a hysterectomy since there is always a possibility that you can't get hemostasis or something accidentally gets ligated. Any malpractice attorney could argue successfully that if you are doing a c/s, you should be able to do an emergency TAH. Trauma surgeons also may run into situations in which consulting ob/gyn to do a TAH is not an option when trying to save the patient.

 

[Leukocyte]

Today I learned a lesson in humility.....

I am currently rotating in Orthopaedic Surgery, and we were consulted by Medicine to evaluate a patient for Osteomyelitis secondary to an infected IM rod in his femur. After seeing the patient, we decided to take him to the OR on Monday to remove the infected hardware, and replace it with an antibiotic coated rod. Also, the patient has gallstones, for which General Surgery was consulted.

Today, during our rounds, the Chair of OrthoSx found a note written by the General Surgery attending saying..."I do not agree with Orthopedics, and I do not think it is a good idea to take him to the OR to remove his rods and pins since this will make him susceptible to pathologic fractures"....After reading the GS note, the Orthosx Chair started laughing....He told us about this, and we all started to laugh. As we were finishing our rounds, we accidentally bumped into the General Surgeon who wrote that note. The Orthosx Chair stopped him, and asked him why he does not agree with us about taking him to the OR. Then he stared talking to him in "Orthopaedic Lingo" and asking him questions, which even me as a student rotating in Orthopaedics should know. The GS attending's face got all red and sweaty, then in a pressured tone said..."yeah, yeah, I see your point, we should take him to the OR,"...He then rushed out from our sites.

This incident was hilarious. We all started laughing. Then with his think southern accent, the Orthosx Chair told us..."See boys, you look very stupid when you act like a smart ass and interfere in other people's business."

 

[supercut]

As stated before, many gen surgeons perform hysterectomies. If you do so, you must do it under correct circumstances. (proper training/consent, etc)

But the above poster also has made a good point...you should NEVER write a note stating or implying that another physician is wrong. Discuss your disagreements in private. Dont' give any attorney fodder for lawsuit. Remember that every scrap of paper and every ink mark in the chart is also a legal document.

 

[Espion]

Today I learned a lesson in humility.....

I am currently rotating in Orthopaedic Surgery, and we were consulted by Medicine to evaluate a patient for Osteomyelitis secondary to an infected IM rod in his femur. After seeing the patient, we decided to take him to the OR on Monday to remove the infected hardware, and replace it with an antibiotic coated rod. Also, the patient has gallstones, for which General Surgery was consulted.

Today, during our rounds, the Chair of OrthoSx found a note written by the General Surgery attending saying..."I do not agree with Orthopedics, and I do not think it is a good idea to take him to the OR to remove his rods and pins since this will make him susceptible to pathologic fractures"....After reading the GS note, the Orthosx Chair started laughing....He told us about this, and we all started to laugh. As we were finishing our rounds, we accidentally bumped into the General Surgeon who wrote that note. The Orthosx Chair stopped him, and asked him why he does not agree with us about taking him to the OR. Then he stared talking to him in "Orthopaedic Lingo" and asking him questions, which even me as a student rotating in Orthopaedics should know. The GS attending's face got all red and sweaty, then in a pressured tone said..."yeah, yeah, I see your point, we should take him to the OR,"...He then rushed out from our sites.

This incident was hilarious. We all started laughing. Then with his think southern accent, the Orthosx Chair told us..."See boys, you look very stupid when you act like a smart ass and interfere in other people's business."

And we've gotten consults from Ortho for a lung mass in the left middle lobe. Its scary, but stupidity spans all specialities. It unites, if you will. heh