General surgery

General surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder, appendix and bile ducts, and often the thyroid gland (depending on local referral patterns). They also deal with diseases involving the skin, breast, soft tissue, trauma, peripheral vascular surgery and hernias and perform endoscopic procedures such as gastroscopy and colonoscopy.

In many parts of the world including North America, Australia and the United Kingdom, the overall responsibility for trauma care falls under the auspices of general surgery. Some general surgeons obtain advanced training in this field (most commonly surgical critical care) and specialty certification surgical critical care. General surgeons must be able to deal initially with almost any surgical emergency. Often, they are the first port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as thoracostomy, cricothyroidotomy, compartment fasciotomies and emergency laparotomy or thoracotomy to stanch bleeding. They are also called upon to staff surgical intensive care units or trauma intensive care units.

This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 3 to 15mm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are also able to be repaired laparoscopically. Bariatric surgery can be performed laparoscopically and there a benefits of doing so to reduce wound complications in obese patients. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.

General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.

Surgical oncologist refers to a general surgical oncologist (a specialty of a general surgeon), but thoracic surgical oncologists, gynecologist and so forth can all be considered surgeons who specialize in treating cancer patients. The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volumeŽi.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally acceptedŽeven as common senseŽthat a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer. Surgical oncology is generally a 2 year fellowship following completion of a general surgery residency (5-7 years).

In the United Kingdom, surgical trainees enter training after five years of medical school and two years of the Foundation Programme. During the two to three-year core training programme, doctors will sit the Membership of the Royal College of Surgeons (MRCS) examination. On award of the MRCS examination, surgeons may hold the title 'Mister' or 'Miss/Ms./Mrs' rather than doctor. This is a tradition dating back hundreds of years in the United Kingdom from when only physicians attended medical school and surgeons did not, but were rather associated with barbers in the Barber Surgeon’s Guild. The tradition is also present in many Commonwealth countries including New Zealand and some states of Australia. Trainees will then go onto Higher Surgical Training (HST), lasting a further five to six years. During this time they may choose to subspecialise. Before the end of HST, the examination of Fellow of the Royal College of Surgeons (FRCS) must be taken in general surgery plus the subspeciality. Upon completion of training, the surgeon will become a consultant surgeon and will be eligible for entry on the GMC Specialist Register and may work both in the NHS and independent sector as a consultant general surgeon. The implementation of the European Working Time Directive limited UK surgical residents to a 48-hour working week. The introduction of a sub-consultant grade to enable those who have recently received a UK Certificate of Completion of Training may be necessary.