Chapter 86: Other Specializations for Surgeon Part 2

Urology

Urology deals with the urogenital system, specifically organs such as the kidney, prostate, bladder, urethra, testes, penis, and associated glands. Urologists are surgical specialists who treat patients for problems and diseases of the urinary tract, adrenal gland, and male reproductive system. This includes diseases and conditions such as: kidney stones, urinary tract stones, infection, blood in urine, cancer (prostate, bladder, testicle and kidney), incontinence, pelvic floor problems, erectile dysfunction, and traumatic injury to the urinary tract. Urologists also perform vasectomies and kidney transplants.

Specialist areas include: complex pelvic surgery, uro-gynaecology, andrology and paediatric urology. Some urologists are also specially trained in reconstructive surgery, and they perform surgeries on genitalia abnormalities that are present at birth, as well as assist with patients that have been injured in an accident.

Musculoskeletal

Orthopaedic surgery is specifically focused on the musculoskeletal system. An orthopaedic surgeon takes care of bones, joints, ligaments, arteries, muscles, tendons, and nerves, and also works with fractures and other injuries. Orthopaedic surgeons take care of a wide variety of problems, such as congenital deformities, trauma, infections, tumours, degenerative conditions, cerebral palsy, paraplegia, and metabolic disturbances that fall into the category of musculoskeletal abnormalities.

Orthopaedic surgery is a very broad field and includes a number of specialty areas, such as lower limb joint reconstruction, hip or knee, ankle and foot, upper limb, spine, bone tumours, paediatric orthopaedics, rheumatoid surgery, and sports and exercise surgery. Surgical procedures can take up much of the orthopaedic surgeon's practice, however many conditions can be treated medically or physically through the use of braces, casts, splints, or physical therapy.

Orthopaedic surgeons can specialize in various areas:

Hand Surgery - treatment of diseases, injuries, or abnormalities affecting the upper extremities, and includes the performance of microvascular surgery, which is necessary for reattachment of amputated fingers or limbs

Sports Medicine - injuries to the musculoskeletal system

Pediatric Orthopaedics - children with orthopaedic problems including scoliosis, cerebral palsy, congenital dislocation of the hips, clubfoot etc.,

Spine Surgery - major spine problems as a result of disease, degeneration, or trauma (orthopaedic spine surgeons frequently work with neurosurgeons)

Foot and Ankle Orthopaedics - involving the foot and ankle that are treated by both surgical and nonsurgical techniques

Joint Replacement - damaged or worn-out joints (usually hips or knees) are surgically replaced with artificial devices

Trauma Surgery - patients with critical or multiple injuries to the musculoskeletal system (involves close cooperative efforts with many other specialties in surgery)

Oncology - the management of benign and malignant tumours affecting the musculoskeletal system

Plastic

Plastic surgeons focus on repairing, replacing, and reconstructing defects of the body's covering and its musculoskeletal system underneath so as to restore normal form and function (eighty percent of all plastic surgery is reconstructive surgery). While cosmetic surgery is probably the most visible and perhaps the most glamorous aspect of plastic surgery, it's a relatively small part of the specialty. Plastic surgery may be used not only to enhance a person's looks, but also to restore a patient's appearance following an accident or a bout with cancer or another disease. Cosmetic surgery reshapes normal body parts for aesthetic reasons, while reconstructive surgery repairs or replaces body parts damaged by accidents, illness or malformation.

Plastic surgeons primarily focus on the upper and lower limbs, the craniofacial structures, the oropharynx, the breast, and the external genitalia. They also focus on structures patients feel are undesirable and perform 'aesthetic' surgery on those areas. There are many reasons why people seek out the services of a plastic surgeon, for example: injuries on the face, body, or limbs; burns and scalds; congenital abnormalities; hand and upper limb surgery; facial deformities; cleft lip and palate; excess skin removal; breast reduction and augmentation; and breast reconstruction.

Oral and Maxillofacial

Oral and maxillofacial surgeons work on the facial bones, face and neck (which includes both hard and soft tissue), and treat dental and medical problems involving the oral cavity and the maxillofacial area. The maxillofacial area of the body includes the bones of the forehead, face, cheekbones and the soft tissues. These types of surgeons can specialize in head and neck oncology; adult facial deformity; orthognathic surgery; cleft surgery; and facial trauma management.

A facial and oral abnormality could not only interfere with someone's ability to function normally, it can affect every part of their life. Oral and maxillofacial surgeons have the skills necessary to restore a person's function and appearance, but foremost, a person's ability to live normally. An oral and maxillofacial surgeon is really a combination of both a dentist and a medical doctor - many oral and maxillofacial surgeons have degrees in both dentistry and medicine.

Bariatric

Bariatric surgeons are specialists who specialize in the treatment of obesity with surgery. Bariatric surgery (or weight loss surgery) includes a variety of procedures performed on people who have obesity, such as: reducing the size of the stomach with a gastric band; through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch); or through gastric bypass surgery (resecting and re-routing the small intestine to a small stomach pouch).

Brain

Neurosurgery involves the brain, central nervous system, and spinal cord, and covers everything from pre-operative imaging to the removal of tumours. These types of surgeons diagnose, evaluate, and treat disorders of the central, peripheral, and autonomic nervous systems. They may choose to specialize in: paediatric neurosurgery, neuro-oncology (cancer of the brain), functional neurosurgery (neurological problems such as pain, epilepsy, and movement disorders), traumatology, neurovascular surgery, skull-base surgery, or spinal surgery. Spinal surgery and paediatric neurosurgery are the two largest sub-specialties.

Neurosurgeons often perform multiple procedures in a single day, ranging from simple outpatient treatments to complex brain surgeries. Patient problems may be the result of abnormal development from birth (congenital), from aging or "wear and tear" (degenerative), trauma from a definite injury, infectious, neoplastic from a tumour, or related to other medical conditions or disease.

Otolaryngology

Otolaryngologists (commonly referred to as ENT physicians) are specialists trained in the medical and surgical diagnosis and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck. These specialists are trained in both medicine and surgery.

These types of physicians/surgeons may specialize in: paediatric ENT; head and neck; voice and complex airway; otology (ear); and rhinology (nose). Head and neck oncology and facial plastic and reconstructive surgery are also areas of expertise for the otolaryngologist. As well as seeing patients in an office setting, most otolaryngologists also perform surgeries in an outpatient centre or in a hospital. Otolaryngologists can perform up to 250-300 surgeries annually.

Academic

Academic surgery involves clinical work as well as some research or teaching in a higher education setting. An academic surgeon generally refers to a medical school's department of surgery faculty member. This type of surgeon operates, teaches, and also does research.

Clinicians from the Michael E. DeBakey Department of Surgery at Houston's Baylor College of Medicine wanted to highlight the attributes of these physicians. They turned to their own faculty colleagues at Baylor to uncover how those surgeons effect advancements in medicine. Their analysis produced seven attributes common to each of the surgeons. They:

Identify complex clinical problems ignored or thought unsolvable by others

Become an expert

Innovate to advance treatment

Observe outcomes to further improve and innovate

Disseminate knowledge and expertise

Ask important questions to further improve care

Train the next generation of surgeons and scientists

An academic surgeon is a physician-scientist who "typically devotes years of careful observation, analysis, and iterative investigation to identify and solve challenging or unexplored clinical problems," and then employs available resources in their medical community to support these endeavours.

Podiatric

The specialty of foot surgery may be performed by a physician, such as an orthopedic surgeon, or a podiatrist. Advanced surgical podiatrists focus on advanced surgical techniques, including foot and ankle reconstruction after injury. There are also specialties in geriatrics, dermatology, orthopedics, vascular medicine, diabetes and other areas.