Sitting for ENT surgery?

[Downbytheicu]

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I would appreciate any thoughts, insight, and comments about my brief story. Here's the deal: I am a MS-III at a small school in the southeast, and I'm the kind of guy who has liked just about everything I have studied except ortho and ophthalmology. Medicine, OB/Gyn, Peds, etc., it's all great, and I can see myself enjoying many different fields. I've gone into third year with an open mind.

Here's the twist to the story: I have dysplastic hips. Two hours into a surgery, I start to feel the twinge, and while I can do three hours, I probably would not be able to turn around and do another immediately afterwords. Here's the double twist--I really enjoy working with hands. Not only that, but I am good with them.

So I have on my hands a desire to potentially go into a surgical field, but a physical limitation that would prevent me from going through a general surgery residency. My question essentially boils down to this:
Is there any reason why any ENT surgery could not be performed while seated on a stool, except for tradition? It is my understanding that some of the HNS stuff can be very time consuming, and this would only be a problem for me if it is necessary to do it standing.

Fortunately I have been blessed with very competitive board scores and supportive faculty. I have no illusions about how competitive of a field oto is, but, for now, I would appreciate hearing the feasibility of the idea and whether I should pursue it. Should I choose to pursue it, everything else will work itself out.

Thanks in advance.

 

[gstrub]

When I rotated through there were some sitting cases...typically the microvascular cases as well as anything with the microscope (mastoids, tubes). Some people sit for tonsils. Sitting is standard as well for laryngoscopy, bronchoscopy, etc.

There is no way you could sit for a neck dissection, or a parotid, or any other major head and neck case, I don't believe. I suppose if you were the attending you might be able to swing that, but even then, the logistics of a neck dissection sitting down would be difficult. Unfortunately these tend to be the longer cases, which seems to be the issue you would have.

Is it impossible for you to stand for 3-4 hours? If so, surgery in any field will be a challenge. However, as far as all of the surgical fields go, I think ENT has some of the most "chair time."

Sorry if that's no help...also I have only a couple months experience, so it may be better for Leforte, resxn, neutrapeniaboy etc to comment on this.
Good luck,
G

 

[Downbytheicu]

Thanks for responding. Personally, I don't see how sitting perched on a stool with good foot support provides any less command of the operative field than standing, especially when I can stand if needed to reach, just not for hours upon hours on end. I recently stood for an entire 4 hour surgery, but I don't want to be doing that in my 30s and 40s and on. But, you made the good point that I may be able to swing it as an attending, but that doesn't mean that I could as a Resident.

Does anyone know of any programs that may be more friendly or accommodating in this way?

 

[bobby6]

I'm an ENT attending and I sit for the majority of my cases. It is difficult to sit for a neck dissection or an open thyroidectomy but I do sit for parotidectomies, sinus surgery, facelifts, otoplasties, blepharoplasty, ear or mastoid surgery, laryngoscopy/bronchoscopy, tonsils.....etc. You could also sit for transoral robotic procedures and robotic thyroidectomy.

It may difficult to sit for cases during residency depending on the attending and the culture of the ENT institution. The majority of my attendings at one hospital all stood for their sinus surgery and another hospital all sat.

Once you get out of residency, I do think you can find a way to sit for most of your cases like I do and be efficient operatively.

 

[Leforte]

Agreed that it would be pretty easy to sit for most of our cases. I will often sit for parotids, ears, etc, but stand for sinus, thyroids, necks. Other attendings sit for sinus cases. I don't know anyone who sits for thyroids (although if you are doing bigger incisions, I suppose you could get away with it).

The issue I would see would be in residency. When learning to do necks, septoplasty, etc, it would be very challenging to have you sitting and the attending trying to show you what to do without them possibly tripping over the stool. It you are doing a 3 cm thyroid incision, it necessitates excellent retraction and often leaning far over the patient to see though the incision to ensure that you are where you need to be. It would not be impossible, but would make many people who are trying to teach you a bit frustrated, I would assume.

That being said, if you are strong in all other aspects of being a resident, most are willing to go the extra length to accomodate your needs. Obviously there is the whole ADA thing, which require that your needs be met in the workplace if you have a documented disability.

 

[Downbytheicu]

Thanks for the insight Leforte. I had not considered that. I appreciate the insight. It seems that it can be done, especially since I can actually stand when needed, but just not for the entirety of the case. It just may be difficult to find a program willing to work with me. Is anyone familiar with any programs that may be friendlier and more accommodating? In my experience, everyone is "accommodating", but only some are actually interested in providing the flexibility necessary so that it can be done well, in a different way, while others joint point at the roadblocks. Does anyone know of a flexible program or should I just start calling around?