Surgical
Divisions / surgical divisions books
Surgery is performed by specially trained medical
physicians known as surgeons. General surgery training and training
in some surgical specialties, such as neurosurgery, which concerns
the brain, spinal cord, and peripheral nerves, and orthopedic surgery,
which repairs the bones and joints, is conducted in association
with a hospital and usually lasts from five to seven years. At the
end of this period, known as a residency, the general surgeon may
receive further training to learn the skills of a particular specialty,
or subdivision, of surgery. Surgical subdivisions include, for example,
thoracic surgery, which is concerned with diseases of the chest;
vascular surgery, which corrects diseases of blood vessels; plastic
surgery, which reconstructs or cosmetically improves features of
the body; and pediatric surgery, which is concerned with operations
on children.
General surgery is the broadest surgical division, focusing on surgery
of the abdomen, the breast, and the endocrine organs-the glands
and tissues of the body that secrete hormones for controlling growth,
development, and other bodily functions. General surgeons operate
on the appendix, colon, small intestine, gallbladder, stomach, pancreas,
spleen, and liver. Pediatric surgery is a subdivision of general
surgery that focuses on the unique conditions of operating on infants
and children-their organ systems are not fully developed, and anesthetics
and medications must be adjusted for their smaller bodies. The most
common pediatric procedures include correction of birth defects
and removal of abnormal growths that are potentially cancerous.
Colon and rectal surgery procedures are performed on the anus, rectum,
and intestines. These include operations to treat hemorrhoids (enlarged
veins around the anus), polyps (usually benign growths), and cancer.
In a colostomy, surgeons remove all or part of the large intestine.
An opening called a stoma is then made in the abdomen, which allows
the colon to empty waste into a specially designed plastic bag located
outside of the body. An ileostomy is a similar operation in which
the lower part of the small intestine is routed to the stoma.
Neurological surgery involves operations on the brain and spinal
column. These procedures include excising, or cutting out, brain
tumors and removing ruptured discs in the spine, an operation known
as a laminectomy. The use of specialized imaging equipment, such
as computed tomography (CT) and magnetic resonance imaging (MRI),
permits surgeons to identify the exact location of some tumors,
making surgery to remove these growths more precise and less harmful
to surrounding healthy tissue.
Gynecology encompasses a variety of procedures, including surgery
to remove diseased reproductive organs such as the uterus (Hysterectomy);
surgery to remove tumors of the breast; and procedures to correct
female infertility or facilitate permanent contraception (Tubal
Sterilization). Obstetrics is a division that focuses on all aspects
of a woman's pregnancy and may involve procedures such as a cesarean
section, the surgical delivery of a newborn infant, or an episiotomy,
a surgical enlargement of the vaginal opening.
Ophthalmic surgery involves operations on the eye and often requires
the use of microsurgical techniques performed under a microscope.
Such procedures include the removal of a cataract (a clouding of
the lens of the eye) and implantation of an artificial lens to restore
vision; reconnection of a detached retina to the back of the eyeball;
and radial keratotomy (RK), an operation on the cornea to correct
nearsightedness.
Orthopedic surgery entails operations on bones, muscles, and joints.
Orthopedic surgery allows for the replacement of hip and knee joints
with artificial joints made of special metals and plastics. Fractures
in bones are repaired with the implantation of pins, metal plates,
and screws. These techniques greatly reduce the time needed for
healing and recuperation. A subdivision of orthopedic surgery is
sports medicine, which treats injuries and coordinates physical
rehabilitation of amateur and professional athletes.
Otolaryngology involves the medical and surgical treatment of diseases
of the ears, nose, tongue, larynx (vocal cords), and neck, which
includes the esophagus, trachea, and blood vessels. Treated diseases
include cancers of the head and neck. Radiation therapy and chemotherapy
regimens have reduced the need for radical operative removal of
these cancers. Significant advances have also been made in restoring
the ability to swallow and speak following operations of the neck.
Plastic surgery encompasses cosmetic procedures to improve appearance
and reconstruct damaged parts of the body such as skin and underlying
muscle. Cosmetic procedures include enlarging or reducing the size
of the breasts; rhinoplasty (cosmetic surgery on the nose); face
lift (cosmetic surgery to tighten facial tissues); and blepharoplasty
(cosmetic surgery on the eyelids). Reconstructive procedures include
modifying tissues and scars to minimize deformities due to birth
defects, prior operations, or traumatic events like car accidents.
New developments in three-dimensional computer software imaging
help plastic surgeons simulate the results of a particular procedure
to show a patient the visual results possible before surgery is
performed.
Thoracic surgery deals with surgery of the lungs, chest wall, heart,
and large blood vessels of the chest. Typical procedures include
the removal of malignant cancers and correction of structural birth
defects in the lungs and chest. Cardiac surgery is a subdivision
of thoracic surgery. Cardiac surgeons perform over 400,000 heart
operations annually in the United States. These include coronary
artery bypass graft (CABG) surgery, which restores blood flow through
vessels blocked by atherosclerosis (a buildup of plaque on the inner
walls of the arteries); heart valve replacement surgery, which replaces
damaged or worn heart valves with artificial valves; and heart transplants,
in which a patient's diseased heart is replaced by the healthy heart
of a donor.
Vascular surgery involves replacing or repairing blood vessels,
particularly arteries that deliver oxygenated blood to the body
tissues. Operations on major abdominal arteries that carry blood
to the legs or brain are performed to restore blood flow diminished
by atherosclerosis. A procedure known as carotid artery endartarectomy-removal
of blockages in the carotid artery in the neck-reduces the incidence
of stroke in some patients. Weakness in a blood vessel wall can
result in the development of an aneurysm, a dangerous widening of
the blood vessel. Large aneurysms, which can rupture and cause death,
are removed surgically and the blood vessel is reconstructed using
a synthetic substitute.
Urology deals with kidney disorders, including malignancies, bladder
and ureter problems, kidney stones, male infertility and reproductive
disorders, and diseases and malignancies of the prostate gland in
males. One of the most common operations is transurethral resection
of the prostate (TURP), which removes portions of an enlarged prostate.
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