A Guide to Surgical Specialists

Colon and Rectal Surgery

A colon and rectal surgeon is trained to diagnose and treat patients with various diseases of the intestinal tract, colon, rectum, anal canal, and perianal area through medical and surgical means. This specialist may also deal with the liver, urinary, and female reproductive systems if they are involved with primary intestinal disease. A colon and rectal surgeon has expertise in diagnosing and managing anorectal conditions such as hemorrhoids, fissures (painful tears in the anal lining), abscesses, and fistulae (infections located around the anus and rectum). Training in colon and rectal surgery also provides the specialist with in-depth knowledge of intestinal and anorectal physiology required for the treatment of problems such as constipation and incontinence. They 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. A colon and rectal specialist also performs abdominal surgical procedures involving the colon, rectum, and small bowel for the treatment of cancer, diverticulitis, and inflammatory bowel disease (such as chronic ulcerative colitis and Crohn's disease). These operations may be performed with traditional (open) or minimally invasive (laparoscopic) techniques.

General Surgery

A general surgeon is a specialist who is trained to diagnose, treat and manage patients with a broad spectrum of surgical conditions affecting almost any area of the body. The surgeon establishes the diagnosis and provides the preoperative, operative, and postoperative care to patients and is often responsible for the comprehensive management of the trauma victim and the critically ill patient. The general surgeon has the knowledge and technical skills to manage conditions that relate to the head and neck, breast, skin and soft tissues, abdomen, extremities, and the gastrointestinal, vascular, and endocrine systems.

Surgeons may further specialize in an additional Board certification from the American Board of Surgery in the Folowing areas:

Pediatric Surgery

A pediatric surgeon is a specialist who is trained to diagnose, treat, and manage the preoperative, operative, and postoperative care of the child. They care for and operate on children whose development ranges from the newborn through the teenage years. All pediatric surgeons are board certified in general surgery and then complete two years of additional training before they are eligible to be certified in pediatric surgery. As a result of this additional training, pediatric surgeons have expertise in the following areas of responsibility: neonatal surgery (specialized knowledge in the surgical repair of birth defects in the newborn); prenatal surgery (detect abnormalities and plan for surgical corrections during the fetal stage of development); trauma (knowledge in the surgical care and prevention of traumatic injuries); pediatric surgical oncology (knowledge of the diagnosis and surgical care of children with tumors and growths); and surgical problems of the gastrointestinal tract, such as inflammatory bowel disease, appendicitis, gastroesophageal reflux, (reflux of food from the stomach to the esophagus or trachea). Pediatric surgeons are also trained to care for certain surgical problems of the neck, skin and soft tissues, vascular and endocrine systems.

Vascular Surgery

A vascular surgeon is a surgical specialist who cares for patients with diseases that affect the arteries, veins and lymphatic systems exclusive of the heart and intracranial (within the brain) circulations. Hardening of the arteries or atherosclerosis is a common cause of vascular disease. Specialists in this field perform open operations, endovascular catheter-based procedures, and non-invasive vascular testing and interpretations. Common problems treated include stroke prevention by managing arterial blockages in the neck and upper chest, revascularization of upper and lower limbs for poor circulation, management of aneurysms such as occur in the abdomen and elsewhere, vascular trauma, and varicose veins. Treatment also includes angioplasty—stenting of arterial blockages, repair of abdominal aneurysms by less invasive endovascular techniques, as well as medical management of vascular disorders. Vascular surgeons are board certified in general surgery and then complete additional training and testing in vascular surgery.

Surgery of the Hand

This specialty focuses on the investigation and treatment of patients with 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. All hand surgeons are certified in general surgery and then complete additional training and testing in hand surgery.

Critical Care Surgery

This specialty focuses on the surgical and medical diagnosis and treatment of critically ill and injured patients, particularly the trauma victim. Specialists have the knowledge, skills and compassion to provide timely, safe, effective and efficient patient-centered care and manage the patient with multiple organ problems. They also coordinate the teams of doctors and nurses needed for the care of the critically ill and injured patient. Surgeons in this discipline are board certified in general surgery and then complete additional training and testing in critical care surgery.

Neurologic Surgery

A neurological surgeon provides operative and nonoperative management (prevention, diagnosis, evaluation, treatment, critical care and rehabilitation) of patients with disorders of the brain, spinal cord, spinal column and peripheral nerves, including their support structures and blood supply. They also evaluate and manage disorders that affect the function of the nervous system and the operative and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders of the brain, meninges (membranes covering the brain and spinal cord), skull, spinal cord and vertebral column. This also includes the carotid and vertebral arteries, the pituitary gland, spinal fusion or instrumentation, and disorders of the cranial and spinal nerves. Pediatric neurosurgeons manage children with head injuries, brain and spinal tumors, vascular malformation, seizures disorders and hydrocephalus.

Obstetrics and Gynecology

Obstetrician/gynecologists provide medical and surgical care of the female patient. The focus for this speciality is on the female reproductive system, including performing surgical procedures, managing the care of pregnant women, delivering babies, and rendering gynecologic care, oncology care, and primary health care for women.

Specialty certification in obstetrics and gynecology includes:

• Gynecology Oncology
  An obstetrician/gynecologists who is certified in ob/gyn and then has an additional three to four years of specialized training in the treatment of gynecologic cancers including special surgical training and has subspecialty certification through the American Board of Obstetrics and Gynecology for the comprehensive management of patients with cancer unique to women. This specialist provides comprehensive management of women with precancerous and cancerous conditions of the female reproductive system. Expertise in surgery, chemotherapy and indications for radiation therapy supports continuity of care of the gynecologic cancer patient.
  
  
• Maternal Fetal Medicine
  An obstetrician/gynecologists who is certified in ob/gyn and has additional training in obstetrics and has sub-specialty certification through the American Board of Obstetrics and Gynecology. This individual cares for patients with complications of pregnancy and has advanced knowledge of the obstetrical, medical and surgical complications of pregnancy and their effect on both mother and their fetuses. This specialist has expertise in the current diagnostic techniques and treatments for woman with complicated pregnancies. Special expertise also exists in the use of sonography in pregnancy.
  
  
• Reproductive Endocrinology and Infertility
  An obstetrician/gynecologists who is certified in ob/gyn and has additional training in reproductive medicine and has sub-specialty certification through the American Board of Obstetrics and Gynecology. This individual manages patients with complex problems related to reproductive medicine, including assisted reproductive technology, in vitro Fertilization, reproductive surgery, infertility, menopause, contraception, endometriosis and other reproductive disorders.
  
  
• Female Pelvic Medicine and Reconstructive Surgery
  An obstetrician/gynecologists who is certified in ob/gyn and has additional training in the management of the female bladder and pelvic floor. Disorders managed by this sub-specialty include disorders requiring advanced vaginal and laparoscopic surgery, female urinary incontinence, pelvic organ prolapse, vesico-vaginal fistula, and female anal incontinence.

Ophthalmologic Surgery

An ophthalmologist specializes in the comprehensive care of patients with disorders of their eyes and vision. Ophthalmologists are medically trained to diagnose and medically and surgically treat all ocular and visual disorders, including prescribing glasses and contact lenses. These specialists also treat problems affecting the eye and it structures, the eyelids, the orbit, the visual pathway, and acquired onset of double vision in adults and children from neuronlogical and endocrine conditions such as stroke with cranial nerve palsies and thyroid-related eye disease. Cataract operations and basic glaucoma procedures are commonly performed by these specialists. Ophthalmologists may also have additional expertise in the following areas: adult strabismus, cornea and external disease, glaucoma, neuro-ophthalmology, ophthalmic pathology, ophthalmic plastic surgery, pediatric ophthamology and vitreoretinal diseases.

Oral and Maxillofacial Surgery

An oral and maxillofacial surgeon specializes in dentistry which includes the diagnosis, surgical and adjunctive treatment of patients with disease, injuries and defects involving both the function and appearance of the oral and maxillofacial region. This specialty includes care of the oral cavity and face, removal of diseased and impacted teeth, anesthesia for dental procedures, dental implants, facial trauma, pathologic conditions (tumors or cysts), reconstructive and cosmetic surgery,facial pain including temporomandibular joint disorders, correction of dentofacial (Bite) deformities and birth defects. Certification requires completion of training in an accredited residency program, evidence of post-training experience, and successful completion of written and oral examinations on the entire scope of the specialty.

Orthopaedic Surgery

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. Specialized care is provided for patients with musculoskeletal problems including congenital deformities, trauma, infections, tumors, metabolic disturbance of the musculoskeletal system, deformities, injuries an degenerative disease of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon also is involved with treatment of secondary muscular problems in patients who suffer from various central or peripheral nervous system lesions such as cerebral palsy, paraplegia, or stroke, as well as includes conditions that are treated medically or physically through the use of braces, casts, splints, or physical therapy.

Specialty certification in orthopaedics includes:

• Orthopaedic Sports Medicine
  An Orthopaedic Sports Medicine specialist provides care for all structures in the musculoskeletal system directly affected by participating in sporting events. The specialist is proficient in the conditioning, training, and fitness of the body as it relates to athletic performance and the effects of athletic performance and the impact of dietary supplements, pharmaceuticals and nutrition on athletes short and long term health and performance.
  
  
• Surgery of the Hand
  A specialist trained in the investigation, preservation and medical surgical and rehabilitation treatment of patients with 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.

Otolaryngology – Head and Neck Surgery

An otolaryngologist—head and neck surgeon—provides medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems, and related structures of the head and neck. They diagnose and provide medical and surgical treatment of diseases and have skills and knowledge in audiology and speech-language pathology; the chemical senses; allergy, endocrinology, and neurology as they relate to the head and neck. Operations are performed on the head and neck, and face. Head and neck oncology, facial plastic and reconstructive procedures, and the treatment of disorders of hearing and voice are fundamental areas of expertise for the otolaryngologist. .

Specialty certification in otolaryngology—head and neck surgery includes:

• Neurotology
  A neurotologist is an otolaryngologist—head and neck surgeon—who treats patients with diseases of the ear and temporal bone, including disorders of hearing and balance.
  
  
• Pediatric Otolaryngology
  An otolaryngologist—head and neck surgeon— has completed specialty training in the management of infants and children with congenital or acquired disorders of the head and neck, nose, paranasal sinuses, ear, and aerodigestive tract.
  
  
• ·Plastic Surgery within the Head and Neck
  An otolaryngologist—head and neck surgeon—has completed additional training in plastic cosmetic and reconstructive procedures within the head, face and neck. This area includes skin, head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery.

Plastic Surgery

Plastic surgeons specialize in the care of patients requiring 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.

Specialty certification in plastic surgery includes:

• Surgery of the Hand
  This specialty focuses on the investigation and treatment of patients with 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. All hand surgeons are certified in plastic surgery and then complete additional training and testing in hand surgery.
  
  
• Plastic Surgery within the Head and Neck
  A plastic surgeon with additional training in cosmetic and reconstructive procedures with in the head, face and neck. This area includes skin, head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery.

Thoracic and Cardiovascular Surgery

Thoracic surgeons specialize in management of patients with conditions of the chest and heart. This speciality includes providing surgical care of patients for coronary artery disease; cancers of the lung, esophagus, and chest wall; abnormalities of the heart, 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. They have specialized 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 technique.

Urology Surgeon

A surgeon who specializes in urology manages patients with benign and malignant (cancerous) 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.

Revised January 11, 2007

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by the American College of Surgeons, Chicago, IL 60611-3211