What is the most intense type of surgery?

[ArrogantSurgeon]

What I mean is which type of surgery is still found to be intense/nerve-racking for even seasoned surgeons?

I've heard that pediatric cardiac surgery is this way because no case is considered routine due to the often complex abnormal cardiac anatomy. Any others?

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[chicagosurgres]

Even though I have done about 15 Whipple procedures I still get a little tachycardic at certain points of the procedure, and find that I have a tension headache at the end of the case from concentrating. A big liver resection can get a little exciting when you get into audible bleeding.

 

[DrDavid]

Liver transplant

The anat. is complicated, and there are lots of blood vessels to deal w/. Bleeding can be profuse, in part because liver disease can cause clotting deficiencies. There are many places where things can go wrong, and they can be difficult to predict.

 

[RajMahal]

Are you guys only talking about scheduled procedures? In my opinion, trauma surgeons are what legends are made of. In Philadelphia, there's a tactic known on the street as the "Broad Street Special" or the "North Philly Special". This is where people will intentionally shoot their victim (usually related to inter-gang-affairs) in the lower abdomen so that in the event that they survive, they have to get a colostomy bag. Anyway, I think that GSW's are the thing that Trauma surgeons most dread.

 

[droliver]

Actually, penetrating trauma is often easier to triage and fix versus blunt injuries, especially with civilian type firearms (ie. low velocity ammunition). The injuries tend to be more anatomic & discrete, whereas blunt trauma tends to tear & avulse and cause more bleeding (unless you hit spot on a major vessel with the missle or knife). Triaging is definately more complicated for blunt injuries as many can ultimately be tx. non-operatively, sorting that out can be very ulcer-forming at times.


For my money, the most stressful thing I can think of are the emergent surgical airway situations that crop up ocassionally. Anyone who says "Oh, just crich him" have little appreciation how hard that can be in real life very quickly with unfavorable conditions (fat necks, thrashing patients, bleeding,etc...)

 

[Skylizard]

Originally posted by RajMahal
...Anyway, I think that GSW's are the thing that Trauma surgeons most dread...

When I was doing trauma a year ago, we loved penetrating/sharp/GSW traumas. They almost always went OR and were not as common as we would like. It was cool to try and follow the trajectory and piece things back together. We enjoyed them quite a bit.

The blunt stuff was tough. We often would obseve for 12-24hr and then end up in the OR with peritonitis and corn in the abdominal from a strange anatomical disruption.

LS

 

[Mango]

Did a case last week that the cheif resident and one of our Hepato-Biliary/Pancreas docs said was one of the biggest cases they've ever done:

Pt with neuroendocrine(prob carcinoid) tumor, head of pancreas + two liver mets:

1. Open Chole
2. Total Omentectomy (he had at least five pounds)
3. Intra-op ultra sound with RFA of segment 7 met
4. Wedge resection of segment 4 met
5. Whipple with en bloc resection of SMV due to invasion
6. Harvested left IJ
7. Grafted IJ into former SMV/potal vein

Total: 12 hours of marathon surgery, and I loved every minute of it!

Incidentally, after initially doing very well, the pt got septic with a fluid collection/abscess, most likely from the pancreatico-J. IR tapped it, and after a couple days of Abx, he's back on the floor, and doing great!

 

[apma77]

technically most difficult is clipping of a basilar tip aneurysm!

 

[neo]

i dont know about most intense but pediatric airway foreign bodies are pretty damn stressful. here you have a PERFECTLY HEALTHY baby or small child who has aspirated a peanut or something and is quickly desat-ing and will die unless you remove the foreign body ASAP from the airway. the child's parents are waiting outside in desperation and everyone in the OR is watching you intently. yeah, i'd say its pretty intense.