General surgery



General surgery, despite its name, is a surgical specialty that focuses on surgical treatment of abdominal organs, e.g. intestines including esophagus, stomach, colon, liver, gallbladder and bile ducts, and often the thyroid gland (depending on the availability of head and neck surgery specialists) and hernias.

Scope
With the prevalent trend for increasing sub-specialisation in today's medical practice, General Surgery has somewhat lost some of its former glory and scope. Nonetheless, it continues to be a competitive, rewarding and highly demanding specialty in its own right. Until recently, all surgeons had to have gained fellowship in the College of General Surgeons (or such equivalent) in order to progress into further sub-specialty training. However, recently, the College of Surgeons has been divided into separate sub-branches, whereby Fellowship in General Surgery is not necessarily required, but may well be desired - depending on the country and centre of practice, as well as the individual sub-specialty.

Certain sub-specialties are still part of the General Surgical training program. That is, General Surgeons may subspecialise into one or more of the following disciplines:

Breast surgery
In Australia, Canada, the United States, and the United Kingdom, general surgeons are responsible for breast care, including the surgical treatment of breast cancer. In some other countries, breast care falls under Obstetrics and Gynecology.

Trauma
In the United States, the overall responsibility for trauma care falls under the auspices of general surgery, some general surgeons obtaining advanced training and specialty certification in this field alone. A General Surgeon must be able to deal with any surgical emergency. Often they are the first port of call to a critically ill patient, and must perform a variety of procedure to stabilise a patient, such as craniotomy, cricothyroidectomy and chest draining procedures.

Colorectal surgery
Involves evaluation and treatment of complaints from the lower intestinal tract - the large bowel, rectum and anus. A large part of this care involves management of Colorectal cancer, as well as more trivial ailments such as Hemorrhoids.

Upper gastro-intestinal surgery
Surgical management of conditions involving the esophagus, stomach, liver, spleen, gall bladder. Cholecystectomy, the surgical removal of the gall bladder, is one of the most common surgical procedures done world-wide.

Endocrine surgery
Specialising in surgical removal of endocrine glands - most commonly the thyroid, the parathyroid glands and adrenal glands.

Transplant surgery
A transplant surgeon must be ready at any time, when called to harvest organs from a suitable donor. Transplantation of organs must be done as quickly and as meticulously as possible to optimise the chances of a successful transplant.

Vascular surgery
Historically, Vascular surgery was part of the General Surgical program, although recently it has formed its own college. Nonetheless, vascular trainees must complete are certain number of General Surgical terms.

In addition to the above, a General Surgeon may deal with a plethora of less emergent procedures- depending on the training of the Surgeon. Procedures such as treatment of varicose veins, circumcision, vasectomies and skin cancer removal are often done by General Surgeons. This is especially the case in rural areas, where sub-specialist level care is not always available.

Trends
In the last few years minimally invasive surgery has become more prevalent. Considerable enthusiasm has built around robotic surgery (also known as robotic-assisted surgery), despite a lack of data suggesting it has significant benefits that justify its cost.

Training
In Canada, Australia, New Zealand, and the United States general surgery is a five-year residency and follows completion of medical school, either (MD, MBBS, MBChB, etc) or (DO) degree. Following high school, it takes approximately thirteen years to make a fully licensed general surgeon (four years undergraduate training, four years medical school and five years residency).

Subspecialization
In many countries general surgery is a prerequiste for subspecialization in:
 * vascular surgery,
 * thoracic surgery and
 * cardiac surgery.