What surgical speciality is the most technically challenging?

Discussion in 'Medical Students - MD' started by HoboCommander, Sep 21, 2014.

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  1. HoboCommander

    HoboCommander 7+ Year Member

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    In terms of manual dexterity and intellectual difficulty, which surgical specialty is the most technically demanding? Cardiothoracic? Neurosurgery? Or Hand?

    Which is the least challenging? Ortho? Abdominal? Or derm?
     
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  3. HoboCommander

    HoboCommander 7+ Year Member

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    CABG looks so difficult to do. Yet in hand surgery, searching and connecting the little nerves and arteries of a severed finger looks awfully difficult. Ironically, the hand surgeon I know has such poor manual dexterity she has problems opening a can of coke. In brain surgery, those hemorrhages squirting blood everywhere can be hard to control.
     
    Last edited: Sep 21, 2014
  4. ebasappa

    ebasappa Momma said knock you out. 5+ Year Member

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    I've been told neurosurgery can be one of the hard ones, especially when operating on the brainstem areas where there are many delicate neural tracts. Then again, I haven't shadowed/ watched enough videos to compare to others.
     
  5. Lucca

    Lucca Will Walk Rope for Sandwich SDN Moderator 2+ Year Member

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    This is probably a better question for Allo since the third years know more about the finer details than we do.
     
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  6. RueTay

    RueTay 7+ Year Member

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    Hand is a subspecialty of Ortho
     
  7. JPA178

    JPA178 2+ Year Member

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    Hand also often falls under the realm of plastics because of all the microvascular anastomosis involved. Plastics is very technically challenging for that same reason - any free flap will involve many hours of squinting through a microscope and performing anastomosis on tiny vessels with a needle the size of a baby's eyelash.

    In fact, anything requiring a microscope is very technically demanding. Besides plastics, ENT and Neuro do a lot of microsurgery.

    Whipples are also very challenging, but it's not an extremely common surgery so general/hepatobiliary surgeons spend most of their time doing other procedures.
     
  8. Ismet

    Ismet PGY-fun! SDN Administrator 5+ Year Member

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    Moving to Allo
     
  9. HoboCommander

    HoboCommander 7+ Year Member

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    How does a pre-med like you know all this stuff? Amazing...
     
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  10. JPA178

    JPA178 2+ Year Member

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    Haha, I'll take that as a compliment. I've spent about a year doing surgical research.
     
  11. j306c954

    j306c954 2+ Year Member

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    Neurosurgery hands down. There's a reason residency is 7 years :\ Haha. I have also shadowed two neurosurgeons. One small slip of the hand and you could potentially paralyze someone. I mean I am sure all of the other specialties are extremely technical as well, but the repercussions of making any slight error during a neurosurgery are far more severe (and maybe equal to cardio).
     
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  12. ebasappa

    ebasappa Momma said knock you out. 5+ Year Member

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    I want to shadow a Neurosurgeon during my current gap-year soooo badly, it seems so interesting. I always imagined surgery being done on the brain but someone told me most surgeries are actually on the spine/brainstem area?
     
  13. j306c954

    j306c954 2+ Year Member

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    I just got lucky that my Dad was friends with a neurosurgeon. Regarding the brain surgeries, they are very minimally invasive now because of technological advances. I saw a brain biopsy where the surgeon just took a sample of a mass in the frontal lobe like it was no big deal at all. It's seriously like a video game.

    I also shadowed a spinal fusion of a patient that was in a bad car accident. The incision was seriously the length of her entire lumbar region. And yes, many of the surgeries they perform are in fact spinal. To be board certified they must be able to perform both.
     
  14. dienekes88

    dienekes88 7+ Year Member

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    Congenital Heart Surgery is my vote for most technically demanding. Reconstructing those tiny little baby hearts with their complicated anatomy has to be the pinnacle of Surgery.

    CABG is pretty tricky, but it should be attainable for most people with a lot of practice, 3.5x loupes, and a very good assistant.

    Off Pump CABG is not for everyone on account of how difficult it is to do well. Doing a really good durable mitral repair is not easy.

    Not knocking neurosurgery, but the length of residency isn't always directly related to technical skill. Also, two of those years are spent in the lab. If we are counting lab years, General Surgery is 7-8 years. I have heard that some Integrated Plastics programs are moving to a 7-year residency by adding a research year. At 6 years each, the longest residencies in terms of clinical time are Integrated Cardiothoracic and Integrated Plastics.

    The way I have seen it done is: ortho-hand and plastics-hand alternate hand call, but if it is microvascular hand stuff, it is Plastics.

    The Whipple is a great operation. Doing liver resections laparoscopically is also quite difficult, e.g. lap left triseg.
     
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  15. Jay K

    Jay K nullum gratuitum prandium 5+ Year Member

    Podiatry - they spend all those years training just to operate below the ankle; There are literally 53 different CPT codes/ways just to do a bunionectomy.
     
  16. tiedyeddog

    tiedyeddog 7+ Year Member

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    Neurosurgery only involves a year to year and a half of research now.

    My vote is neurosurgery. Spinal cases are not that technical but cranial cases can be insanely technical, especially skull base tumors and oncology related surgeries. Of course, there is a wide variation in any surgical field. There are plenty of bread and butter cases in neurosurgery that aren't very technical, just like I am sure there are in every field.
     
  17. Mad Jack

    Mad Jack Critically Caring Gold Donor 2+ Year Member

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    Fetoscopic surgery is pretty ridiculous.
    [​IMG]
     
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  18. member1000765

    member1000765 2+ Year Member

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    This topic always devolves into a pissing contest between specialties. The truth about it is that in every specialty there are very technically challenging operations that require finesse, and trying to say which one is more technically difficult is a moot point, because it depends on what your level of training is. Sure neurosurgery is 7 years. Head and Neck Surgery with microvascular training is 7 years, pediatric surgery ends up being about 10 years (5 gen surg, 2-3 research, 2 fellowship), congenital cardiac surgery is around 10 years, etc etc. You also don't really know exactly how technically difficult a surgery is until you actually do it, and while there is a component of natural ability, much of it is sheer practice and repetition. As a med student you watch attendings who are graceful and make surgery look so easy, and the first time you pick up a scalpel as an intern you realize wait, this isn't so easy after all. And surgical skills often don't translate across specialties. Put a neurosurgeon in a laparoscopic case and watch him/her struggle with completely difficult skill set and anatomy. "Who has the best hands?!" is always the question, but the best surgeon has an unshakeable knowledge of anatomy, knows the steps of the procedure cold, and adapt to whatever special situation is presented to them while maintaining a calm demeanor as well as having good hands. And those surgeons exist in every specialty.
     
  19. Serous Demilune

    Serous Demilune 2+ Year Member

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    It's gotta be related to dick size, no?
     
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  20. SouthernSurgeon

    SouthernSurgeon Lifetime Donor 7+ Year Member

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    Isn't everything?
     
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