Anticipation of the needs of surgeon while

assisting
Prepared by:
Aimable ABAHINIYEHAMWE ,PGY1
Supervisor: Dr. Emmanuel MUTABAZI, General Surgeon
introduction

• Anticipation means “Be Prepared” for the next step to avoid time
wastage

• Read about the operation beforehand in an operative text

• learnt its different steps

• Know the operation Key-points

General Conduct
Relation with theatre staff:
• Treat them like human
• Be kind and ask advice & guidance (or room order, materials, machine
usage, scrubbing,gowning,degloving)

Be friendly and professional:

• On the patient: even in G.A (avoid careless,unkind remark about the
patient’s physique
• On staff: avoid making comments that the operation is not proceeding
well or the surgeon or staff is not doing a good job
General conduct
• Punctuality: Communicate at any impendiment

• Assist in pre-op preparation:

Labs or imaging
operative or anaestesia requirement
• In case of delayed operation. Keep reading
(Anatomy,operative steps&methods)

• Accepts Surgeon operating methods: it may be the one

which works well one him/her
General conduct
Know Operation room Personnel

• Doctors( Team)
• Nurses (Team)
• Scrub nurse: (They will not like it if you hoard instruments next to yourself,
beyond their reach)
• Scout or running nurses
• Anaestetic nurses
• Theatre orderies ( Cleaner)
• Radiographer
 The middle course is safest and best

• Activity vs Passivity

• Stress: Don’t be over or under-stressed

• Talking in O.R: Surgeon/operation dependent. Classify your subject based on importance

• Mobile phone: Placement/ frequency of call

• Food and drinks: Full stomach & empty bladder

• If you Faint: Admit and excuse then next avoid.

• Know Dimensions: e.g: Cut or suture at 2cm

Pre-Operative
• Familiarize with the patients: Name, social hx etc.

• Key points:
• What is the disease, where is it, symptoms, examination findings.
• Right-investigations,
• Medical problems especially affecting surgery (ex: Warfarin usage)
• Possible complications
• In ideal world there may be no time: Take history& do examination
and read-case-note(Key points).
Pre-operative e.g
• E.g. Kalisa, 47y.o, who was a farmer, to be operated for gastric ca
• Pathology:
How was the Dx made? ( Read endoscopy report)
Where exactly the cancer(Anatomical site)
Did the whole stomach objectivated?
CT-Scan
• Potential complication:
Obstructive symptoms?,
anemia, malnutrition,
extragastric spread( Liver enzymes, CT-scan, US,CXR)
Pre-operative

• Put relevant imaging or reports on Imaging viewing box

• Help positioning the patient

• Respect the anesthesia team especially during induction

• Insert the Foley catheter if needed

• Cleaning and draping

• Ensure the diathermy plate is in place safely.
Intra-Operative
• Concentrate on your task

• Avoid intra-op Incident: Eye-splash, needle prick….

• Move with the site of surgical action:

Deeper as in aorta exploration

linear(Hemi-colectomy)

circular ( Umbilical hernia repair)

• Re-adjust your retractors to provide the best view for the surgeon.
Intra-operative
• When the surgeon is tying a suture, be ready to cut the suture when it
is held up for you to do so.

• Hold the scissors with their tips about 10 cm away from the suture.

• As soon as the suture is held up for cutting, glide your hands quickly
but smoothly forward and cut

• Be certain the surgeon wants it cut and not clipped

Intra-operative
• Clip and cut: hold the clip in one hand, and the scissors in the other. I need
of several clips, you can ask the scrub nurse to have all clips together

• Familiarize with Repeated steps( E.g clipping and ligation of the

mesentery in Colon resection)

• Tactfully ask the scrub nurse for materials.

• Ask the surgeon what type of sutures to use and if he will need drains or not
Intra-operative
• Adjust the light source: Sterile light handle,
third unsterile personnel, ask other mobile lamp

• Respect sterility and sterile zone

• Always set well instruments and the operation
table avoid instrument overclouding
I.O: Steady hands(Tips)

• Stand with your feet about shoulder-width

apart
• Rest your pelvis or lower abdomen gently
and carefully against the operating table
• Have your elbows flexed at about 90°
• Have straight, relaxed back
• If short ask for a step to stand on
• If tall maybe stand with your legs further
apart
• Try to use both hands when assisting
• Do not allow your hands to cross over each
other
I.O: Improve surgeon view
• In an open wound, try to give the surgeon the largest area of access
that you can,with the site of surgical action in the middle
• Think on the shape of the hole
General operation stages
1. Preparation by the anesthetist

2. Setting up (positioning the patient and equipment)

• patient positioning and applying anti-thromboembolic devices
• Shaving, skin preparation and draping

3. Marking the incision with a surgical skin-marking pen

4. Entry : Incision of the skin and other tissues overlying the operative site,
such as fat, muscle, fascia and bone
General operation stages

5. Mobilization: The process of freeing up of the organ

of interest, from surrounding structures

6. The key therapeutic objectives:

• Incision (e.g. drainage of an abscess)

• Excision: investigation (e.g. lymph node biopsy); or
definitive treatment (e.g. cholecystectomy)
General operation stages
6.The key therapeutic objectives…

• Evacuation(SDH),
• Exploration
• Manipulation (e.g. antireflux surgery)

• Implantation:
prosthetic material (e.g. repair Of AAA, hip replacement).
donor tissue (transplant)
General operation stages

7. Reconstruction : e.g anastomosis of the terminal ileum to the

transverse colon after right hemicolectomy

8. Haemostasis (‘stopping the bleeding’) done through the operation

with a final check toward the end
General operation stages

9. Washing out (also known as irrigation

or lavage): Remove foreign bodies( Clot, fatty tissue…), culture medium for
infection control

10 +_ Drain insertion

11. Closure of the wound :Some or all of the layers of the wound

12. Local anesthetic instillation

13. Dressing
Some e.g Key or danger points

• In thyroidectomy, avoid injury to the recurrent laryngeal nerve, and

the external branch of the superior laryngeal nerve.

• In cholecystectomy, avoid injury to the bile duct.

• In right hemi-colectomy, avoid injury to the ureters and duodenum….

Anticipation: Take away

• You will be able to give the surgeon the best assistance if you
understand what he or she is trying to do.

• If you are unsure of what the surgeon is trying to achieve, and you feel
that you are not helping the surgeon to the best of your ability
• it is best simply to admit this, and ask
THM
• The best assistant is the one who let the surgeon see where he/she is
operating
REFERENCES
• Surgical tips and skills, Felix Behan 2014
• Assisting at Surgical Operations A Practical Guide Edited by Comus
Whalan BMBS MD FRACS
• Basic surgical tecniques R M Kirk Fifth Ed. 2002