So you want to become a specialist surgeon?
First, you will need to become a medical doctor (general practitioner). Becoming a medical doctor requires, depending on the state/country you live in, that you obtain a premedical science degree and follow it up with a medical degree. Some medical schools combine these two degrees into a single degree.
Second, you would be wise to gain practical experience for at least a number of years as a general practitioner before considering specializing in one of the branches of medicine.
Third, you’ll have to apply for admission as a candidate to the training program of the surgical department of a medical school. The admission criteria for a trainee as a general surgeon are strict and competition is usually fierce.
What are the attributes that I need to become a surgeon?
- A strong desire to become a surgeon. This is very important. Do not even think of pursuing surgery as a career if you are still in any measure unsure about your decision.
- Perseverance. Embarking a career that will require formal studies of 10 years or longer will stretch and strengthen your ability to persevere.
- The ability to work under pressure.
- The ability to handle crises.
- The ability to work hard, and for long hours continuously.
- The ability to keep your concentration for extended periods of time.
- A fair amount of physical dexterity. Dexterity is an acquired skill – although only to a certain extent. If you have 5 thumbs on each hand, do not hope to become a micro-surgeon!
- You need to like working with your mind and your hands.
- You need to like working with people.
- Respect for the human body and for human life.
- If you are a medical student you need to love anatomy. A thorough knowledge of anatomy is the foundation of surgery.
- Intelligence. If you really struggle with your studies despite putting in effort daily, you may benefit from submitting yourself for psychological assessment to ascertain if you have the intellectual ability to become a doctor or a surgeon.
The History of Surgery
The Egyptians practiced surgery as early as 1600 B.C. and papyrus scrolls vividly describe the splinting of fractures, the care of wounds, the drainage of abscesses, etc.
Hippocrates (400 B.C.) commonly described as “the father of medicine”, for example, wrote books on surgery; surgery of piles and the treatment of head injuries.
During the Middle Ages surgery was mainly performed by barbers as part of their duties. Surgery was progressively reclaimed by scientific medicine in the 16th to 18th centuries.
John Hunter, a Scottish surgeon (1728-1793) taught his students that a surgical operation was the last resort – an admission that other methods had failed.
Two seemingly insurmountable stumbling blocks prevented any progress in the field of surgery, namely the excruciating pain associated with undergoing surgery and the almost inevitable fatal wound infections occurring after surgery – especially surgery to the abdomen, chest, and skull.
One of these obstacles was overcome in the 1840’s with the introduction of anesthetics, and the other in the 1860’s when an English surgeon, Joseph Lister introduced the principles of surgery without infection.
The 20th century saw a rapid expansion and refinement in anesthetic technique, anesthetic agents and machines, sterility and asepsis and the discovery of antibiotics – all allowing surgery to expand into many sub-surgical disciplines, with new, safer and less invasive surgical techniques becoming the routine surgical procedures of today.
The development of the heart-lung machine made safe surgery to the heart possible – culminating in the first successful human heart transplant by Professor Christiaan Barnard, a South African heart surgeon in 1967.
Basic Principles Applied in Surgery
- Diagnosis and preoperative assessment
A wrong diagnosis usually implies inappropriate, ineffective and occasionally outright dangerous treatment!
- The consideration of alternative non-surgical treatment modalities. Surgery is and should be the last resort!
- Proper treatment planning
It is said that a good surgeon always operates twice – firstly he /she plans the operation in detail in his/her mind before doing the real operation. Assisting the surgeon in this planning process are: tracings, computer assisted simulations, model surgery etc.
- Minimum invasion
- Scope assisted surgery versus an open surgical procedure.
- Interventive radiology/angiography
Surgical procedures to the heart requiring opening of the chest, are being replaced in some instances by minimally invasive procedures performed by accessing the inside of an artery and performing the relevant procedure with radiographic (X-ray) assistance!
- Good visual conditions
- Exposure of the surgical site. This takes place when the surgical incision is made and dissection is performed to reach the intended surgical site.
- Retraction. Retraction is the “pulling” away of tissue to offer the surgeon maximum exposure to the surgical site.
- Lighting. Surgical assistants and nursing staff have noted that good surgeons always seem to complain about the light.
- Suctioning and sponging. This is necessary to remove excess blood which may obscure the operative field.
- Some noted physicians in history were handicapped by blindness, not so with surgeons though!
- Handle tissue gently causing as little injury as possible
- This basically amounts to having respect for the human body as well as an understanding of the processes involved in the repair and healing of wounds.
- Good control of bleeding within the limits of:
- Minimal electrocautery
- Minimal suturing
- Minimal sponging
- Every action must be purposeful. For safety and economical reasons operating theater time is of essence. Do not waste time in the OT.
- Sterility and asepsis. All surgical instruments must be sterile (the complete absence of microorganisms) and the operative field must be as aseptic (minimizing and weakening microorganisms) as possible.
- Anatomical considerations. A surgeon needs to have a detailed knowledge of the structure of the human body.
- Physiological considerations. A surgeon needs to have a comprehensive knowledge of the functioning of the human body.
- Patient considerations
- Social. Certain diseases are more prevalent in specific socioeconomic groups.
- Religious. The transfusion of blood or transplantation of organs is a taboo in certain religious groups.
- Financial. What are the financial implications of the proposed operation to the patient/healthcare organization?
- Expectations as to the outcome and success of the operation.
- Information (e.g., proposed procedure and alternative procedures, pain and discomfort, pre- and postoperative instructions)
- Implications. Will the patient be able to continue with normal activities e.g. studies/work/sport/hobbies? If not, will this be temporary or permanent? Does the patient need a medical certificate?
- Complications. What can go wrong during and after the operation?
- Prognosis. What is the success rate of the surgical procedure, and for how long will the benefits of the operation last?
Various disciplines in the field of surgery:
- General surgery (the whole body)
General surgery has a number of sub-specialties e.g.:
- Vascular surgery (arteries and veins)
- Pediatric surgery (babies and children)
- Head and neck surgeon
- Proctologist (anal and rectal areas)
- Thoracic surgery (heart and lungs)
- Plastic and reconstructive surgery (cosmetic procedures and the repair of a body part after the loss of tissue e.g. an ear)
- Ear, nose and throat surgery
- Neurosurgery (brain and spinal cord)
- Orthopedic surgery (bones, muscles and joints)
- Maxillofacial and Oral surgery (face, facial skeleton, mouth and related organs)
- Dental surgery (teeth, mouth and jaws)
- Obstetrics and gynecology (pertaining to the developing fetus and the female reproductive organs)
- Urology (male and female urinary tract)
- Ophthalmic surgery (contents of the eye socket)
Types of surgery
- Open surgery. An example of open surgery would be a surgeon making an incision with a steel scalpel in the abdominal skin to perform an abdominal operation.
- Scope surgery. An example would be when a surgeon makes a number of small stab incisions in the abdominal wall to perform an operation within the abdominal cavity using a scope to visualize the operative field.
- Electrosurgery. A surgeon can “burn” away diseased tissue or make a surgical incision while electric current seals off blood vessels at the same time, thus avoiding excessive bleeding!
- Aspiration. Fluid and diseased tissue can be removed by a needle for laboratory examination.
- Cryosurgery. Diseased tissue can be destroyed by freezing it.
- LASER surgery. Applications of this type of surgery are: ophthalmic surgery, cosmetic surgery, surgery to the skin and mucous membranes.
- Ultrasonic scalpels. These scalpels make surgical incisions with minimal bleeding possible.
- Shock waves . An example of this type of surgery is the breaking-up of a kidney stone by shock waves instead of removing it by open or scope surgery.
Complications of surgery
- Common to all surgery
- Excessive bleeding during or after an operation
- Infection of a surgical wound
- Loss of function. An inability to perform tasks or activities after the operation that were possible before the operation.
- Non pleasing aesthetic outcome. This is often very subjective (a specific individual’s opinion) and relates to unrealistic patient expectations.
- Sinuses and fistulas (small canals and holes)
- Delayed healing and non-healing wounds. For example, a broken bone may take a very long time to heal, or not grow together at all.
- Pigmentation and loss of normal pigmentation
- Over exuberant healing
- Keloid (a growth-like scar of a surgical wound)
- Scarring (usually harder than the adjacent tissue and often cosmetically not pleasing)
- Neurological complications. This may manifest as loss of special sense e.g. vision, loss of feeling in a specific area, loss of control of a voluntary muscle and loss of autonomic functions e.g. bladder control.
- Rejection. An example would be the rejection of a transplanted kidney.
Frontiers of surgery
- Robotic surgery. A surgeon performing a delicate operation using a simulator is actually operating on a patient quite a distance away. Possible applications are, operating in a battlefield situation and performing an operation in space on an astronaut.
- Tissue engineering. This is an exciting frontier. Medical scientists can already grow specific types of tissue e.g. cartilage and bone from the patient’s own cells, thereby avoiding the risk of rejection! The growing of an organ e.g. a kidney from the patient’s own cells appears to be just around the corner!