How to assist an operation

Dr. Isa Basuki

[Taken from Assisting at Surgical Operations A Practical Guide
(Cambridge Clinical Guides)]
Introduction to the operating
theatre
General conduct in the operating theatre
• Relationship with theatre staff
• The middle course is safest and best:
• Activity versus passivity
• Stress
• Talking in the operating theatre
• Pagers and mobile (cell) phones
• Food and drink
• If you feel faint
• Know dimensions
Universal Precautions
• Transmissible disease in the operating theatre
• If you suffer a needle-stick injury
• If you suffer an eye splash
Clothing in the operating theatre
• Scrubs
• Other operating theatre clothing
• Hat
• Face mask
• Eye protection
• Footwear
• Jewellery
• Re-entering the operating suite
Personnel: who’s who in the operating
theatre
• Doctors
• Nurses
• Instrument nurses or ‘scrub nurses’
• Scout nurses or circulating nurse
• Anaesthetic nurses
• Other personnel
• Theatre orderlies
• Radiographers
The operation itself
Preparing for the operation
• read up in advance about the operation you will be assisting at
• Familiarise yourself with the patient
• ensure you understand the key points about the patient
• put relevant X-rays up on light box
• Check the shave
• Insert a urinary catheter
• Help position the patient
• Ensure the diathermy plate is in place safely
General intra-operative principles
• Concentrate on your task
• Anticipation
• Sharps
• Adjusting the light source
• Steady hands
• Improving the surgeon’s view
General stages common to operations
• Preparation by the anaesthetist
• Setting up (positioning the patient and equipment)
• Patient positioning
• Applying anti-thromboembolic devices
• Shaving
• Skin preparation
• Draping
• Marking the incision with a surgical skin-marking pen
• Entry
General stages common to operations
• Mobilisation
• The key therapeutic objective
• Incision
• Excision:
• Investigation
• definitive treatment
• Evacuation
• Exploration
• Manipulation
• Implantation:
General stages common to operations
• Reconstruction
• Haemostasis (‘stopping the bleeding’)
• Washing out (also known as irrigation or lavage)
• Drain insertion
• Closure of the wound
• Local anaesthetic instillation
• Dressings
Sterility and the ‘sterile zone’
• do not enter the ‘sterile zone’
• do not walk between two sterile areas (between the scrub nurse’s
trolley and the draped patient)
• if your gloved finger accidentally touches something unsterile  stop
using that hand  request a new glove
• Waterproof gowns
• Scrubbing
• When to scrub
• Scrub technique
Sterility and the ‘sterile zone’
• Drying the hands • Where to put your hands
• Gowning • Shaving, antiseptic painting and
• Gloving draping
• Glove size • Clipping the drapes
• Glove type • Setting up instruments
• Donning gloves • Incise drapes
Tissue planes: traction and counter-traction
• If you can see the correct tissue plane, you will greatly help the
surgeon by gently retracting the tissue on one side of it 
countertraction
• Counter-traction can be achieved by several different methods:
• mainly using instruments
• occasionally the fingers
Surgical instruments: their names and how to
use them
• Types of surgical instruments
• Basic instruments
• Cutting instruments
• Scalpels: Barron and standard handles
• Scissors
• The correct scissor grip
• Cutting sutures
• Placing clips on sutures
• To cut or to clip?
• Handling multiple clipped sutures
Surgical instruments: their names and how to
use them
• Types of surgical instruments • Types of surgical instruments
• Basic instruments • Basic instruments
• Gripping instruments • Non-ratcheted: forceps (never
• Ratcheted ‘tweezers’)
• Atraumatic • Retractors
• ‘Heavy’ • hold themselves in place
• Clips • must be held in place by the
• Types of ratcheted clips hand of the assistant
• Non-ratcheted: forceps (never • Special equipment
‘tweezers’)
• Suture material
• Suckers
• The sump sucker
• Fine suckers (e.g.Yankaeur)
Surgical instruments: their names and how to
use them
• Types of surgical instruments • Types of surgical instruments
• Diathermy • Haemostatic techniques
• Types of diathermy • Assisting with the different
• ‘Touching’ with the diathermy haemostatic techniques
• Clip and tie
• Haemostatic techniques
• Removing ligature clips
• Assisting with the different
• Loaded ties
haemostatic techniques
• Clip and double-tie
• Simply ignore it
• Suture
• Diathermy  Dabbing
• Transfixion-ligation
• Gauze swabs,
• The ‘peanut’,
• The swab-on-a-stick
• Types of surgical instruments
• Haemostatic techniques
• Preventing suture material from tangling
• ‘Following’ a suture line
• Placing packs to protect suture material
• Drains
• Prosthetic materials
Immediately after the operation
Immediately after the operation
• it is better to help with some of the innumerable small jobs:
• Put the X-rays back in their packet
• Help wheel in the patient’s bed
• help transfer the patient onto it from the operating table
• Fill in forms (histopathology request forms)
• prescribe the patient’s drugs or non-drug treatment orders
• The usual custom is for the doctor who does the operation, to write
the formal operation record
• If the surgeon you are assisting is ignoring this custom, you may be
asked to write it.
THANK YOU