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Anticipation Need

This document provides guidance for surgical assistants to effectively anticipate the needs of surgeons in the operating room. It emphasizes the importance of being prepared by reading about surgical procedures beforehand and knowing the key steps and points. Assistants are advised to maintain professionalism, focus on their tasks, and tactfully ask for necessary materials. The document outlines general conduct expectations and stages of operations. It also provides tips for improving a surgeon's view and examples of key points to remember for certain procedures. Overall, the goal is for assistants to help surgeons efficiently by anticipating next steps and providing the best assistance possible.

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rutikanaga william
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139 views24 pages

Anticipation Need

This document provides guidance for surgical assistants to effectively anticipate the needs of surgeons in the operating room. It emphasizes the importance of being prepared by reading about surgical procedures beforehand and knowing the key steps and points. Assistants are advised to maintain professionalism, focus on their tasks, and tactfully ask for necessary materials. The document outlines general conduct expectations and stages of operations. It also provides tips for improving a surgeon's view and examples of key points to remember for certain procedures. Overall, the goal is for assistants to help surgeons efficiently by anticipating next steps and providing the best assistance possible.

Uploaded by

rutikanaga william
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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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

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