The American College of Surgeons recognizes 14 surgical specialties: cardiothoracic surgery, colon and rectal surgery, general surgery, gynecology and obstetrics, gynecologic oncology, neurological surgery, ophthalmic surgery, oral and maxillofacial surgery, orthopaedic surgery, otorhinolaryngology, pediatric surgery, plastic and maxillofacial surgery, urology, and vascular surgery. The information that follows presents information on the various surgical specialties. The material was adapted from definitions put forth by the nationally recognized authority on the topic, the American Board of Medical Specialties (ABMS), and its approved surgical specialty boards.
A general surgeon is a specialist who is trained to manage a broad spectrum of surgical conditions affecting almost any area of the body. The surgeon establishes the diagnosis and provides the preoperative, operative, and post-operative care to patients and is often responsible for the comprehensive management of the trauma victim and the critically ill patient. During at least a five-year educational period after obtaining a medical degree, the surgeon acquires knowledge and technical skills in managing medical conditions that relate to the head and neck, breast, skin, and soft tissues, abdominal wall, extremities, and the gastrointestinal, vascular, and endocrine systems.
Thoracic surgery involves the operative management, perioperative care, and critical care of patients with pathological conditions within the chest. Specifically, it includes surgical care for coronary artery disease; cancers of the lung, esophagus, and chest wall; abnormalities of the great vessels and heart valves; congenital anomalies; tumors of the mediastinum; and diseases of the diaphragm. The management of the airway and injuries to the chest are also areas of surgical practice for the thoracic surgeon. A thoracic surgeon possesses the knowledge, experience, and technical skill to diagnose accurately, to operate upon safely, and to manage effectively patients with intrathoracic abnormalities that are appropriate for surgical treatment.
The ability to provide this kind of treatment requires a substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of extracorporeal circulation, cardiac assist devices, management of cardiac dysrhythmias, pleural drainage, respiratory support systems, endoscopy, and other invasive and noninvasive diagnostic techniques.
Colon and Rectal Surgery
As a result of their extensive training and experience, colon and rectal surgeons develop the knowledge and skills necessary to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal, and perianal area through medical and surgical means. They are also able to deal surgically with other organs and tissues (such as the liver, urinary, and female reproductive systems) involved with primary intestinal disease. A colon and rectal surgeon has expertise in diagnosing and often managing anorectal conditions in the office, such as hemorrhoids, fissures (painful tears in the anal lining), abscesses, and fistulae (infections located around the anus and rectum). Colon and rectal surgeons also treat problems of the intestine and colon and perform endoscopic procedures to detect and treat conditions of the bowel lining, such as cancer, polyps (precancerous growths), and inflammatory conditions.
Colon and rectal surgeons also perform abdominal surgical procedures involving the small bowel, colon, and rectum, including treatment of inflammatory bowel diseases, such as chronic ulcerative colitis, Crohn’s disease, diverticulitis, and cancer. Training in colon and rectal surgery also provides the surgical specialist with an in-depth knowledge of intestinal and anorectal physiology, which is required for the evaluation and treatment of problems such as constipation and incontinence (loss of bowel control). Colon and rectal surgeons are committed to the highest standards of care for patients with diseases that affect the lower gastrointestinal tract.
Obstetrics and Gynecology
A specialist in obstetrics and gynecology is a physician who has been trained to provide medical and surgical care for the pregnant patient, to deliver babies, and to provide medical and surgical care to treat conditions that affect the female reproductive system. Some obstetricians/gynecologists have a strong professional interest in a specific area such as urogynecology, pelviscopy, adolescent/pediatric gynecology, or infectious diseases, and they focus their practice on one or more of these particular areas of the specialty. All of these physicians are also trained in health maintenance and preventative care for women, and they have a particular knowledge and skills that enable them to serve as consultants to physicians who practice in other areas of medicine.
There are also subspecialties in obstetrics and gynecology, which require additional training: maternal-fetal medicine specialists are obstetricians /gynecologists who are prepared to care for, and to consult on, patients with high-risk pregnancies; and reproductive endocrinologists are capable of managing complex problems related to reproductive endocrinology and infertility, including aspects of assisted reproduction, such as in vitro fertilization (IVF).
A Gynecologic Oncologist is a specialist trained in the comprehensive management of patients with gynecologic cancer–cancers that affect the female reproductive system. Surgeons practicing in this specialty study these conditions, which differ significantly in the cause, prevention, detection, treatment, and survival rates.
Neurological surgery is the discipline of medicine and the specialty of surgery that deals with the diagnosis, evaluation, and treatment of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply. Neurological surgery involves the evaluation and treatment of pathological processes that modify the function or activity of the nervous system, including the pituitary gland.
An ophthalmologist is concerned with the comprehensive care of the eyes and vision, and is the only medical practitioner who is medically trained to diagnose and treat all eye and visual problems. Ophthalmologists provide vision services (glasses and contact lenses), treat medical disorders of the eye, and perform surgical procedures for treatment.
Oral and Maxillofacial Surgery
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries, and defects in the head, neck, face, jaws, and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, and tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
Orthopaedic surgery is a surgical specialty that is specifically devoted to the care of the musculoskeletal system. This system includes bones, joints, muscles, associated nerves, arteries, and the overlying skin. Much of the orthopaedic surgeon’s practice involves the performance of surgical procedures, but many conditions are treated medically or physically through the use of braces, casts, splints, or physical therapy. Orthopaedic surgeons take care of a wide variety of problems that may be present at birth, or that may develop at any time during the lifetime of the person. Such problems can include congenital deformities, trauma, infections, tumors, degenerative conditions, and metabolic disturbances that fall into the category of musculoskeletal abnormalities. Orthopaedics may also involve the treatment of secondary muscular problems in patients who suffer from various central or peripheral nervous system lesions such as cerebral palsy, paraplegia, or stroke. The field of orthopaedic surgery has become very broad and now encompasses a number of specialty areas. Following a standard residency experience in orthopaedic surgery, an orthopaedist may continue with an additional one- to two-year fellowship to achieve added qualifications in the following special interest areas.
This specialty focuses on the investigation and treatment of diseases, injuries, or abnormalities affecting the upper extremities. This specialty includes the performance of microvascular surgery, which is necessary for reattachment of amputated fingers or limbs.
This specialty addresses the various concerns of the person who is involved in athletics, including conditioning, equipment, and, of course, injuries to the musculoskeletal system.
Specialists in pediatric orthopaedics address their practice to children with orthopaedic problems including scoliosis, cerebral palsy, congenital dislocation of the hips, clubfoot, and a wide variety of other conditions specifically seen in children–including trauma.
Spine surgeons work with patients who have major spine problems as a result of disease, degeneration, or trauma. Orthopaedic spine surgeons frequently work in conjunction with neurosurgeons.
Foot and Ankle Orthopaedics
This specialty is concerned with problems predominantly involving the foot and ankle that are amenable to treatment by both surgical and nonsurgical techniques.
Specialists in joint replacement take care of damaged or worn-out joints usually by surgically replacing the joint with an artificial device. The majority of cases involve the hip or knee–and sometimes the ankle or shoulder. Most joint replacement in the hand falls into the area of expertise of the hand surgeons.
Because of the complex nature of injuries seen today, a special area of orthopaedics is now related to the management of persons with critical or multiple injuries to the musculoskeletal system. This specialty is largely surgical in nature and involves close cooperative efforts with many other specialties in surgery.
The orthopaedic tumor surgeon specializes in the management of benign and malignant tumors affecting the musculoskeletal system. Options for treatment have expanded greatly in the past few years with the advent of chemotherapy and radiotherapy coupled with the excision of the tumor and replacement with preserved bone or joint specimens.
An otolaryngologist is a physician who has been trained to provide comprehensive medical and surgical care to patients who have diseases and disorders that affect the ears, the respiratory and upper alimentary systems, and related structures. The otolaryngologist has a command of the core of knowledge, skills, and understanding of: the basic medical sciences relevant to the head and neck; the respiratory and upper alimentary systems; the communication sciences, including knowledge of audiology and speech-language pathology; the chemical senses; and allergy, endocrinology, and neurology as they related to the head and neck. Head and neck oncology and facial plastic and reconstructive surgery are also fundamental areas of expertise for the otolaryngologist.
Pediatric surgeons are primarily concerned with the diagnosis, preoperative, operative, and postoperative management of surgical problems in children, and they operate on children whose development ranges from the newborn stage through the teenage years. Some medical conditions in newborns are not compatible with a good quality of life unless these problems are corrected surgically. These conditions must be recognized immediately by neonatologists, pediatricians, and family physicians. Pediatric surgeons cooperate with all of the specialists involved in a child’s medical care to determine whether surgery is the best option for the child. Pediatric surgery focuses on providing surgical care for all problems or conditions affecting children that require surgical intervention. They may also have particular expertise in the following areas of responsibility.
Pediatric surgeons have specialized knowledge in the surgical repair of birth defects, some of which may be life threatening to premature and full-term infants.
In cooperation with radiologists, pediatric surgeons use ultrasound and other technologies during the fetal stage of a child’s development to detect any abnormalities. They can then plan corrective surgery and educate and get to know parents before their baby is born. In addition, prenatal diagnosis may lead to fetal surgery, which is a new forefront in the subspecialty of pediatric surgery. Application of most fetal surgical techniques is still in the experimental stage.
Because trauma is the number one killer of children in the United States, pediatric surgeons are routinely faced with critical care situations involving traumatic injuries sustained by children that may or may not require surgical intervention. Many pediatric surgeons are involved with accident prevention programs in their communities that are aimed at curbing traumatic injuries in children.
Pediatric surgeons are involved in the diagnosis and surgical care of children with malignant tumors as well as those with benign growths.
Plastic and Maxillofacial Surgery
The specialty of plastic surgery deals with the repair, replacement, and reconstruction of defects of the form and function of the body covering and its underlying musculoskeletal system, with emphasis on the craniofacial structures, the oropharynx, the upper and lower limbs, the breast, and the external genitalia. This surgical specialty also focuses on the aesthetic surgery of structures with undesirable form. Special knowledge and skill in the design and transfer of skin flaps, in the transplantation of tissues, and in the replantation of structures are vital to the performance of plastic surgery. The plastic surgeon must also possess excellent skill in the performance of excisional surgery, in the management of complex wounds, and in the use of allopathic materials. Knowledge of surgical design, surgical diagnosis, surgical and artistic anatomy, surgical pathology, surgical oncology, surgical physiology, pharmacology, bacteriology, biomechanics, embryology, and surgical instrumentation are other fundamental areas of expertise within the specialty. Furthermore, the judgment and technical capacity for achieving satisfactory results are mandatory qualities for the plastic surgeon. After completing a residency in plastic surgery, a plastic surgeon may subspecialize in:
Hand Surgery This subspecialty focuses on the investigation, preservation, and restoration by medical, surgical, and rehabilitative means of all of the structures of the upper extremity that directly affect the form and function of the hand and wrist.
Urology A urologist is a physician who manages benign and malignant medical and surgical disorders of the adrenal gland and of the genitourinary system. Urologists have comprehensive knowledge of, and skills in, endoscopic, percutaneous, and open surgery of congenital and acquired conditions of the reproductive and urinary systems and their contiguous structures.
Vascular Surgery Vascular surgeons care for patients with diseases that affect the arteries and veins throughout the body. Hardening of the arteries, atherosclerosis, is the most common problem that vascular surgeons treat. In addition, vascular surgeons are trained to diagnose and treat strokes, which can be brought on by a blockage or narrowing of the arteries in the neck. Because the damage done by strokes is often irreversible, vascular surgeons must be able to make early diagnoses of potential stroke victims. The surgeon who treats the vascular system must also be able to diagnose and treat aneurysms and blood clots in the arteries and veins, as well as the after effects of conditions of the vascular system.