Your LEAST favorite operations (had to do it)

[Thanatos]

Love the other thread, but had to make this one because this is how my mind works.


1. Laparoscopic LAR. Long, kinda tedious and somehow I always end up between the legs sticking staplers up some fat guys ass (sorry SLU)

2. Colonoscopy. Same as above, but awake. "Sir, please try not to move while I shove a telephone pole in your ass."

3. Breast cases (sorry WS). Bleh.....just bleh. Not to mention all the empathy.

Unlike most of us I don't really like reducing hernias at the bedside. I like fixing them, its satisfying afterwards and I think 99% of the medical community really does not appreciate how complex these can be.

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[GreatSaphenous]

Personally, I hate any case where the term pannus is uttered.

On that note, go back to your low-fat diets and healthy exercise regimens.
I am the Great Saphenous!!!!!

 

[dpmd]

Trach/peg on patients who have no chance of meaningful recovery. I don't mind the consult I guess, because at least then somebody talks with the family about whether this is what the patient would really want (as opposed to what the family wants, which is their loved one back to normal so they might say yes to anything they think will give that a chance to happen even if that isn't true).

Needle localized breast biopsies. Maybe our localization guys just suck, but I always feel like I end up digging myself into a hole or taking out way too much breast.

 

[filter07]

lysis of adhesions
skin/subcutaneous surgery including partial mastectomies
anything where the anatomy, goals, or results of an operation are not clear

 

[Dan Plainview]

lysis of adhesions
skin/subcutaneous surgery including partial mastectomies
anything where the anatomy, goals, or results of an operation are not clear

This. Almost anything plastic surgery related. 14 hour DIEP, 4 hour nasoseptorhinorevisionboogerblahblahblah-plasty. Infrainguinal bypasses, Whipples (I know, I know...).

 

[SLUser11]

Love the other thread, but had to make this one because this is how my mind works.


1. Laparoscopic LAR. Long, kinda tedious and somehow I always end up between the legs sticking staplers up some fat guys ass (sorry SLU)

I think a Lap LAR is a wonderful case, but it takes a skillset and level of experience beyond what is required for a chip-shot lap right colon. If they are letting you fire the stapler, it means they trust you, because with leak rates above 10%, this is the most stressful part of the operation for me.

That being said, they shouldn't be too long of a case, or tedious, if things are going well. I've never really experienced residents who don't enjoy lap colon surgery, so this is a first.

As for colonoscopy, I completely understand. I think residents don't get enough of them, so they're not good at them. They simultaneously rank scopes below most surgeries in regards to importance and complexity, so they send the junior resident, even if they aren't good at them yet. That way, they are able to avoid the unpleasant and frustrating experience of struggling....but the side effect is they don't get any better at them....

Then, they graduate with 50-75 colonoscopies, when it takes 3-4 times that amount to become proficient.....and if they choose a career in general surgery, they suddenly realize the importance of endoscopy in surgical practice.

I also think residents over-estimate their proficiency in endoscopy. Anyone can reach the cecum in a 50 year old male, but being able to get the job done (safely) in an obese female patient with previous surgeries/scarring, a loopy sigmoid, long colon, and general intolerance of pain is probably a better measure of ability.

 

[Miami_med]

Breast Reduction. I just feel like I'm doing something so wrong .

 

[Taciturngosamer]

Acute chole. I hate it more every year. The 'older' I get the more I realize how bad you can f~€k that one up.

And every patient believes its going to go perfectly because its "just" a gallbladder operation

 

[Dr.LeoSpaceman]

I actually really enjoy colonoscopy (and endoscopy in general). Mostly because of the challenge it can be, as well as the proportion of good you can do compared to the hurt you put on the patient.

My least favorite surgery is probably the re-do peripheral bypasses. Nothing fun about going into a groin for the 3rd time.

 

[KLPM]

Breast Reduction. I just feel like I'm doing something so wrong .

http://www.huffingtonpost.com/2009/02/04/worlds-biggest-breasts-sh_n_163992.html

 

[45408]

Well, I suppose it's probably good for future business that I kind of like a number of the cases listed above...just like the guys here that do a lot of nasty foot wounds have more business than they could ever dream of.

I liked endoscopy and would like to do some on a regular basis, and I find abdominal hernias +/- EC fistulas to be pretty fascinating. We've had a number of complex ones, and I think it's nice to put all the pieces back together again.


I really dislike leg salvage cases, especially when the patient has limited function in that leg or in general.

 

[Thanatos]

I think a Lap LAR is a wonderful case, but it takes a skillset and level of experience beyond what is required for a chip-shot lap right colon. If they are letting you fire the stapler, it means they trust you, because with leak rates above 10%, this is the most stressful part of the operation for me.

That being said, they shouldn't be too long of a case, or tedious, if things are going well. I've never really experienced residents who don't enjoy lap colon surgery, so this is a first.

As for colonoscopy, I completely understand. I think residents don't get enough of them, so they're not good at them. They simultaneously rank scopes below most surgeries in regards to importance and complexity, so they send the junior resident, even if they aren't good at them yet. That way, they are able to avoid the unpleasant and frustrating experience of struggling....but the side effect is they don't get any better at them....

Then, they graduate with 50-75 colonoscopies, when it takes 3-4 times that amount to become proficient.....and if they choose a career in general surgery, they suddenly realize the importance of endoscopy in surgical practice.

I also think residents over-estimate their proficiency in endoscopy. Anyone can reach the cecum in a 50 year old male, but being able to get the job done (safely) in an obese female patient with previous surgeries/scarring, a loopy sigmoid, long colon, and general intolerance of pain is probably a better measure of ability.

Most of my colleagues enjoy colon surgery, we match several people into CRS every year but it just doesn't do it for me I guess. I don't terribly mind doing lap right hemi's but beyond that I don't care much for it.

I think you're dead on about colonoscopy, I've done around 70-ish but certainly don't feel very awesome at them. Shockingly I don't really enjoy doing things I'm not good at, I like doing upper scopes but think we can all agree those are much easier.

 

[poorracerkid]

EC fistulas by far. Yuck.