Must see surgeries?

[Soze]

---

Members do not see this ad.

Hey folks,

Now that I have my feet wet in internship, I have some time to scrub surgeries after getting the floor work done. I was wondering people's opinions on what surgeries (and surgical management) they'd consider are "must see" for a resident going into radiation oncology. Hopefully this list would help others as well.

I have seen some thoracotomies (w/ wedge and lobe rescections), transsphenoid hypophysectomies, and prostatectomies. What others should be added to the list?

Soze

 

[Thaiger75]

Hey folks,

Now that I have my feet wet in internship, I have some time to scrub surgeries after getting the floor work done. I was wondering people's opinions on what surgeries (and surgical management) they'd consider are "must see" for a resident going into radiation oncology. Hopefully this list would help others as well.

I have seen some thoracotomies (w/ wedge and lobe rescections), transsphenoid hypophysectomies, and prostatectomies. What others should be added to the list?

Soze

Laryngectomies (and various partial versions), neck dissection, breast surgeries (including mastecotomy, lumpectomy, axillary dissection), total mesorectum excision (rectal cancer), whipple, and any robotic-assisted surgeries if your hospital has one.

 

[Wallachia]

sarcoma

 

[stephew]

i agree the head and neck surgeries are most important. also pancreaticoduodenectomy. this will help enormously. good thinking.

 

[G'ville Nole]

Would add to the list:

Thoracic-- Esophagectomy

Gyn-- Rad Hysterectomy, Vulvectomy

Neurosurg-- Vestibular Schwannoma resection, any primary CNS tumor resection (may be tough if not displayed on a view screen)


Others come to mind, but are more in the "nice to see" rather than the "need to see" category.

 

[clintpark]

I wish I could see all of those surgeries. And I have seen some of them... but definitely not nearly enough...

Once you start your rad onc residency, though, how do you manage to see all of these surgeries? Do you just approach surgeons during tumor boards and ask to scrub in for a case on a day your attending is away? (This is what I've done so far.)

Does anyone have an official surgical oncology rotation?

 

[stephew]

id say the acoustic and esophogectomy are nice to see rather than must see. I agree w/ gyn though,.

Would add to the list:

Thoracic-- Esophagectomy

Gyn-- Rad Hysterectomy, Vulvectomy

Neurosurg-- Vestibular Schwannoma resection, any primary CNS tumor resection (may be tough if not displayed on a view screen)


Others come to mind, but are more in the "nice to see" rather than the "need to see" category.

 

[Thaiger75]

I wish I could see all of those surgeries. And I have seen some of them... but definitely not nearly enough...

Once you start your rad onc residency, though, how do you manage to see all of these surgeries? Do you just approach surgeons during tumor boards and ask to scrub in for a case on a day your attending is away? (This is what I've done so far.)

Does anyone have an official surgical oncology rotation?

Yes, we do. That's one of the few perks of our program. Other than our 6-month research elective, we have elective rotations in pathology (1 month), heme-onc (1 month), and radiology/surgery (1 month). During this last mentioned rotation, we get to schedule and see as many surgeries as we'd like and/or spend as much time as we want in the rads dept. These are usually done during the last 2 years. I highly recommend this to your PD if you don't have this opportunity b/c it will the only chance you'll get to stick your nose in these operations (except for intraop cases of course).

 

[Brim]

I have a dissenting viewpoint. I really don't think there's such a thing as a "must see" surgery.

Don't get me wrong. You need to know a little something about these surgeries (for a thousand different reasons). And what better way to learn something than to see it, right?

But in all likelihood, you'll scrub in to something like a radical hysterectomy ...
you'll be standing there, legs tired, but you won't be able to see anything except the surgeon's back. Face it, the only person who really has a clean view of the action is the surgeon and the first assistant... and you're not either of these two. At least you're not having to retract, right?

Now if your hospital has those new-fangled OR cameras that let you get a view of the action like a Goodyear Blimp with 5 degrees of freedom, then we're talking about something entirely different. That might be useful.

But do you really need to SEE a lumpectomy to be able to give adjuvant breast radiotherapy? Do you really need to see a radical hysterectomy to give pelvic RT? Or any brain surgery. Does seeing them operate really help you out at all? I don't think so.

Now there are some where the anatomy is significantly distorted after surgery (e.g. Whipple) and it's good to have a sense of what's changed so you know how to contour the anatomy. Head and neck might fall in these category as well.

But really, are any "must see?" Will your training as a radiation oncologist be slighted somehow if you don't spend an hour in the OR for one example of one of these cases? I don't think so.

I believe that all of these surgeries are truly optional for the radiation oncology resident.

But by all means, "knowing is half the battle" (as a famous cartoon soldier once said). The more you know about cancer and all its aspects, the better doctor you'll be. Learn anatomy. Learn why we treat the volumes we do. Learn what a surgeon removes as a standard part of an operation. These things are more important than going just to see something.

I'm not trying to discourage you from seeing surgeries if you're interested in them... just don't consider them required or necessary.

 

[Thaiger75]

\
But really, are any "must see?" Will your training as a radiation oncologist be slighted somehow if you don't spend an hour in the OR for one example of one of these cases? I don't think so.

I believe that all of these surgeries are truly optional for the radiation oncology resident.

Yes, of course, observing these surgeries are not a requirement or essential to our training and practicing as a radiation oncologist and are optional. But I do believe that they do enhance our understanding of all these related to our field and to fully understand surgeon "speak". In cases where the surgeon needs to go in for salvage resection/dissection (ie. neck dissection or salvage prostatectomy)...we always hear about how difficult the surgery is due to radiation fibrosis...but from our viewpoint, what does that really mean? I think seeing this in action would only enhance our experience. So by all means, if you have the opportunity to do so, see some surgeries, but not doing so will not hinder your education.

 

[stephew]

when you get to the boards you will have to know what the surgeries are. (indeed to be a good radonc doc). Particularly the ones i mentioned. you might even see a laryng. exam and have to interpret it. so while you dont have to take the term "must see" religiously, the point is well taken.