According to the American Medical Association’s Healthcare Careers Directory 2009-2010, surgical first assistants are advanced allied healthcare practitioners who “provide aid in exposure, hemostasis, wound closure, and other intraoperative technical functions that help the surgeon carry out a safe operation with optimal results for the surgical patient. The surgical first assistant performs these functions under the direction and supervision of the surgeon and in accordance with hospital policy and appropriate laws and regulations.”
In their official Statements on Principles, The American College of Surgeons (ACS) describes the role and function of the surgical first assistant as follows:
The first assistant during a surgical operation should be a trained individual who is able to participate in and actively assist the surgeon in completing the operation safely and expeditiously by helping to provide exposure, maintain hemostasis, and serve other technical functions. The qualifications of the person in this role may vary with the nature of the operation, the surgical specialty, and the type of hospital or ambulatory surgical facility.
The American College of Surgeons supports the concept that, ideally, the first assistant at the operating table should be a qualified surgeon or a resident in an approved surgical education program. Residents at appropriate levels of training should be provided with opportunities to assist and participate in operations. If such assistants are not available, other physicians who are experienced in assisting may participate.
It may be necessary to utilize nonphysicians as first assistants. Surgeon’s assistants (SAs) or physician’s assistants (PAs) with additional surgical training should meet national standards and be credentialed by the appropriate local authority…
Adapted from AMA Healthcare Careers Directory 2009-2010
Preoperatively, surgical first assistants work with operating room staff to verify correct patient information, operative procedure, and surgical site and check the patient’s chart for any abnormalities. They also verify that the correct equipment and instrumentation is prepared and ready for use. The surgeon determines the exact position for the best exposure for the surgical procedure, and the surgical first assistant carries out this order. Surgical first assistants are knowledgeable about common patient positions as they relate to the surgical procedure and are able to utilize the necessary equipment (fracture tables, head stabilizers, body stabilizers, C-arm extensions, and other equipment as needed) to provide that position. The patient’s safety and comfort are important considerations. The surgical assistant will ensure that points of pressure are padded, including elbows, heels, knees, eyes, face, and the axillary region. Surgical first assistants also verify that circulation is not impaired, and nerves are protected from damage. Surgical first assistants and anesthesia personnel discuss the patient’s temperature and identify the particular methods that will be implemented to maintain the desired temperature.
Intraoperatively, The surgical first assistant provides visualization of the operative site by appropriately placing and securing retractors, with or without padding; packing with sponges; digitally manipulating tissue; suctioning, irrigating, or sponging; manipulating suture materials (loops, tags, running sutures); and employing the proper use of body mechanics to prevent obstruction of the surgeon’s view. Surgical first assistants utilize appropriate permanent or temporary techniques to help achieve hemostasis by
- Clamping and/or cauterizing vessels or tissue
- Tying and/or ligating clamped vessels or tissue
- Applying hemostatic clips
- Placing local hemostatic agents
- Applying tourniquets
- Applying vessel loops, noncrushing clamps, and direct digital pressure
Surgical first assistants employ appropriate techniques to assist with the closure of body planes, including utilizing running or interrupted subcutaneous sutures; utilizing subcuticular closure technique; closing skin as directed by the surgeon; and administering subcutaneous postoperative injections of local anesthetics when directed by the surgeon. Surgical first assistants select and apply appropriate wound dressings, including liquid or spray occlusive materials; absorbent material; and immobilizing dressing. Surgical first assistants also secure drainage systems to tissue.
Postoperatively, surgical first assistants evaluate the patient for any possible damage resulting from positioning, including assessment of the skin. The surgical first assistant reports any abnormal condition to the surgeon and assists with patient transfer from the operating room. Other postoperative treatment and documentation is carried out as necessary under the direction of the surgeon and in accordance with job description and local and facility policy.
Sugical first assistants are used on a wide variety of surgical cases and work across a broad spectrum of surgical specialties. Many opportunities exist for surgical first assistants to specialize in areas such as cardiothoracic, neurosurgical, orthopedic, peripheral vascular, and other branches of surgery. The majority of surgical first assistants work in hospitals. Many others work for private physicians or surgical specialty groups, for private surgical first assistant groups, and a number are self-employed. Click here for a list of hospitals that employ surgical assistants.