Continuing with my previous post (BEST SPECIALTIES AFTER MS/ DNB GENERAL SURGERY ? (PROS AND CONS) - PART 1), here is the part 2 review of various pathways for specializing after completing MS General Surgery. In this post I will be reviewing following:

Contents

• MCh/ DNB Plastic Surgery
• MCh/ DNB CTVS
• MCh/ DNB Minimally Invasive Surgery

MCh/ DNB Plastic Surgery

• Includes wide number of both Cosmetic and Reconstructive Procedures
• Plastic surgery is not just liposuction and nose jobs, it is much much more than that. Plastic surgery as a branch has a wide spectrum of procedures which includes: Skin, Hand Surgery, cranio-maxillo-facial reconstructions, Tendon Reconstruction, peripheral nerve surgery, burns management, genitourinary reconstructions, oculoplastic surgery, bed sore management, diabetic foot management and the list goes on
• Decent demand in large private setups, high demand in large government and semi government setups
• Usually good load of cases only in big cities
• Procedure time is usually long 
• Patients may have unrealistic expectations from plastic surgeons as popularized on television and in movies
• Easy to get the seat

MCh/ DNB CTVS 

• Usually not preferred by most these days but it does not mean that there is less scope.
• It is still a required specialty in tertiary care hospitals with many procedure both cardiac and thoracic in the armamentarium of Cardiothoracic and vascular surgery. Some examples are Coronary artery bypass grafting (CABG), Heart valve repair or replacement, Ventricular assist devices, carotid endarterectomy, Heart transplant, Surgery in great vessels (aortic coarctation repair, Blalock-Taussig shunt creation, closure of patent ductus arteriosus), congenital heart disease surgeries, Lung volume reduction surgery, Lung cancer surgery, pleurectomy, lung transplant surgery etc. 
• Very demanding in terms of challenges of access during the surgery and the need of long term intensive care support required
• One needs to be very passionate for being a heart surgeon
• Usually the work hours are more as the teams are small and number of hours one needs to put are more
• Very easy to get the seat

MCh/ FNB Minimal Invasive Surgery 

• It is more like extension of your general surgical training
• For those who already have a good hands on in laparoscopic procedures, it might not be very useful
• Limited seats
• Good exposure to Bariatric surgery which we usually do not get in general surgery training
• Good only if taken in high volume laparoscopic surgery centers (only a few centers like GEM, Coimbatore |  Sir Ganga Ram, Delhi| Meenakshi Mission, Madurai | Galaxy, Pune)
• All across India minimal access surgery is being practised largely by general surgeons only
• FNB and Mch MAS at AIIMS are only two courses in India which are recognised by medical council for Minimal Access surgery
• Adoption of Robotic Minimal Access surgery is still in its nascent stages in India, you will require additional training separately

So to conclude, I would say that all specialties have some good things and some bad things. There are some which are in high demand in the job market for freshers, but in the long term, more or less, all specialties offer good scope for talented and deserving surgeons. 

The key to success is always dependent on the amount of interest you take and the amount of hard work you put into nurturing your surgical skills. It also depends on the right choice of institute to work in and an optimal match between the demand of the specialty that you choose and number of doctors already offering those services in your city.  

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8/08/2020 11:49:00 PM

By Dr Christie Bernard on Facebook Group "Learning General Surgery"

"I have been to quite a few conferences and and PG master classes..Few of them I have utilized it to the maximum whereas few I used it to some extent and few went waste .how can a postgraduate attending a conference make the best use of it and what are the basic points to be adhered to . 

1.Being on time 

 Few months ago ,there was a post in the group about how the Indian conferences look vacant in the beginning of the day and subsequently get filled up as the day progresses . This is especially not the case with PG master classes occuring throughout the country.The seats get filled up so very fast and if ur a late comer ,u will be left to sit in the floors or corridors .I have seen ppl sitting outside the door and just hear what's being spoken by peeping in . Being on time also gives u enough time to go thru the days topics and note down the doubts u had in ur mind pertaining to that topic .

2. Attending alone 

I have also found it more productive if I attend a conference alone without the ppl whom I knew (Co-pgs) . U can concentrate more on what's being spoken instead of unnecessary gossips.Moreover u get to make a lot of new friends from other colleges ,get to know their work culture,work style., hands on experiences in their dept .,the variety of cases they do ,their academic schedule and so on 

3 . Interacting with Seniors and speakers .

Very few ppl tend to get up and ask qns..One of the main reasons is shying away ,what if ppl think I'm stupid . There was also a friend of mine,who was passing comments like why do ppl ask such dumb questions..!! Why can't they think themselves and so on.. 

Remember one thing.,.

Any conference is to show ur knowledge or to show ur ignorance..At the end, you learn something and that's all it matters. Who cares about what others think..

Never be afraid of asking even the dumbest  of questions 

4.Volunteering for Case presentations and Virtual ward rounds 

Always be the first to volunteer for case presentations and Virtual ward rounds .I myself was always a bit hesitant to do it and I'm slowly overcoming it .These are all opportunities to expose urself to the real time practical exam experiences. U tend to learn more by standing on the podium than by sitting in the audience and taking notes . 

No one ever scores sitting in the pavilion.

5. Diet and lunch time interactions

Do a little bit of exercise and Have a high protein , high carb diet early in the day before u come .that's keeps u energetic during day time.Eat less during lunch and interact more with new ppl and faculties .Eating less during lunch also keeps u awake in post lunch sessions..U have the opportunity to talk to doyens in various fields and u can talk almost anything from academic to non-academic .No one will shy away from talking to you 

6. Breaking off for tea

It's quite common to find the PGs leaving the hall as soon as the talk is over without waiting for felicitation .Never show ur back to the teachers . Stay there in ur seat till the speakers are felicitated as a token of appreciation and respect for sharing their knowledge 

7. Post session 

When we attend some master class in a new place,we always tend to go for parties discos pubs and movies once the day is over. Personally I have never found them helpful. Stick to the purpose for which u had gone there . U can come back and revise what was taught the whole day and clear ur doubts the next day. Parties discos and pubs u can go whenever u want but interacting with surgeons of repute ,u don't get it often . 

List of PG conferences and Master classes of repute ( Random order) 

1. MAMC surgery update ,Delhi

2. SCOPE - Surgery clinical oriented Post Graduate examination course ,Delhi 

3. RRC - Regional Refresher course ( organised By ASI ; Happens in different zones ) 

4. KGMU surgical update ,Lucknow 

6. CSEP- Continuing Surgical Education programme ,.st.johns Banglore 

7. ARRC - Annual Rapid review ,Sri Ramachandra univ. Chennai 

8. Stan Surgicon - Stanley ,Chennai 

9.BMC update,Banglore

10.ASICON 

Seniors plz add ur valuable inputs so that it benefits us and PGs plz add up the PG master classes and conferences which u have found useful  so far"

10/25/2019 04:39:00 PM

Steps for Below Knee Amputation Surgery (Without Bone Bridge)

Following are the gross steps for doing a below knee amputation surgery, for detailed steps please check out these links ( Link1 and Link2 ) .

Marking the incision for flap using following parameters

• Anterior incision 10cm distal to tibial tubercle
• Anterior incision 2/3 total circumference
• Posterior incision 1/3 total circumference
• Posterior flap should be distal to the musculotendinous junction of the gastrocnemius
• Round out the distal ends of the posterior skin flap to reduce redundancy of skin upon closure

Putting the Incision and Anterior Soft Tissue Dissection

• Incision is deepened in layers
• Saphenous vein is clamped and ligated;
• Anterior incision is then carried through all tissues to bone
• Now one can identify anterior tibial artery and veins, and deep peroneal nerve anterior to interosseous membrane; anterior neurovascular bundle can always be identified by spreading between the tibialis anterior and the EHL muscles
• Incision is carried out thru lateral compartment, superficial peroneal nerve is identified, ligated proximally and cauterized

Transection of Fibula

• Fibula is transected 1-2 cm proximal to the level of the tibial transection. Periosteum of the fibula is elevated proximally before transection

Tibial transection

• Periosteal layer of the tibia is cut sharply 1 cm distal to the level of the skin and elevated proximally about 1-1.5 cm, leaving a layer for suture of the posterior musculature
• Tibia is sectioned with power saw 1 cm distal to skin edge and anterior cortex is beveled obliquely

Posterior Flap Dissection

• Posterior muscle mass is sharply and carefully freed from its attachments to the tibia and fibula distally to the level of the posterior skin incision
• Posterior tibial artery & veins and the peroneal artery and veins are individually clamped and tied
• Tibial nerve is pulled, cut proximally and allowed to retract
• Deep muscles: tibialis posterior, FDL, FHL are transected just distal to the level of the tibia and allowed to retract;
• Soleus muscle is isolated and excised, leaving the gastrocnemius as sole muscle of the myocutaneous flap
• Sural nerve is pulled, cut proximally and allowed to retract

Myodesis

• Drill holes just anterior to the bone bevel for myodesis
• Use a locking style Krackow suture through the gastrocnemius aponeurosis and secure it to the tibia
• Place a submuscular drain
• Secure the borders of the gastrocnemius to the proximal anterior fascia

Final Steps

• Wound is closed in layers
• Soft dressing is applied
• Cast is applied to immobilize the knee  to avoid a postoperative flexion contracture

2/11/2018 06:00:00 PM

This is a laparoscopic operation simulator with USB camera. It can be connected to a PC. It is ideal for surgery students, medical schools and for CME courses offering laparoscopic training.

Feature list

• Small-type training box with 5 silicone holes.
• Endoscope can be connected to a PC by USB
• 300,000 dynamic pixel , manual focusing.
• Operating Systems; Winxp,Win7,Win8 Operating System, not compatible with a Mac system.
• Pledget pad for suture training.

Purchase Link: Click here to buy

Below are few more images.

 

Keywords: Surgery Simulation, Laparoscopy, Laparoscopy Techniques, Learn Surgery

7/31/2017 07:40:00 PM