SA role in the Intraoperative Surgical procedure.

SA role in the Intraoperative Surgical procedure.

A competent Surgical Assistant (SA) is a well-trained medical professional who helps the surgeon or nurse in all medical operations. They have prior and after surgery, specific roles in ensuring a successful surgery or a medical procedure.

Such prior roles in the preparation of the Intraoperative procedure are to ensure that all equipment and tools required for the operation are clean, sterilized, assembled in proper working order, and monitored readily awaiting the surgery. SA also helps in the preparation of the patients before surgery by interviewing the patients on medical history. SA should also prepare all the paperwork is already compiled, filed and placed in the clean and ready to use the room

During the operation, SA is the direct assistant to the surgeon and performs all the basic surgical duties such as positioning of the clients in preparation for surgery and, if experienced, to administer local anesthesia. To implants surgical devices or drain, suction the surgical site, place catheters, hemostasis, tissue handling, and dressing of incision sites in line with procedures under the supervision of a surgeon as per the laid guidelines and monitoring the electronic equipment and updating the team on the patients’ vital signs. He helps the surgeon to concentrate on technical procedures. After the surgery, the SA clean and restock the operating room for possible next operation or any other use.

The role and characteristics of the professional FA during surgery

First Assistant (FA) is a professional individual who is trained and can participate actively to assist the surgeon in completing the successful medical operation. During the surgery, FA has various vital roles that include positioning the patients. Preparing all the instruments like needles, counting sponges, and any other material that is necessary for the surgery. Cleaning and clearing the operation sites for the surgeon and also use equipment like retractor to hold incision sites. Assisting the surgeon to make and close the incision sites while maintaining hemostasis where tissue has been removed or manipulated. Selecting and passing thee supplies required by the surgeon during the surgery. To implants, surgical devices or drain, suction the surgical site, place catheters, clamp, and cauterize blood vessels in line with procedures under the supervision of a surgeon. To confirm that the surgical site is clean and no left devices. Should be competent to apply and change the dressing.

Additionally, a competent FA should help to insert trocars, preparation of the grafts, or any other role assigned by the surgeon.

Characteristics of the professional FA during surgery should demonstrate the capacity to perform general surgical skills. Such includes proper communication with the surgeon on the preferences of the patients’ needs.

Should demonstrate the capacity to apply and advanced pathological knowledge of human physiology and anatomy and possible take according to the assessment.

Competence in visualization and trocars insertion, monitoring hemolysis sand handling of tissues. Awareness of surgical procedures and the ability to anticipate possible surgeon preferences.

Should work independently or as collaboratively with the surgeon for successful completion of the surgical operation. SA should be Calm and courageous during surgery to be useful, while critical surgeries are in progress. This helps to maintain harmony and confidence among the team operating.

Tissues are most delicate during operation; hence the manner of handling affects the outcome of any procedure (Allen, 2016). SA being the immediate assistant in surgery, has to be steadfast in handling any tissue.  Some of the tissue handling techniques suggested revolves around the Halsted principle that involves the following techniques.

Gentle tissue handling involves minimizing the postsurgical pain. SA uses the knowledge of human anatomy and physiology to inform the surgeon on the possible implication if a particular tissue if separated or cut without reason. If tissue is already dissected correctly along the fascial planes, it must be protected from potential contamination or dying.

Meticulous homeostasis is a technique achieved through ligation, maintaining pressure, and the use of a high-frequency current in a small area of tissue sealing it (electrocoagulation) to avoid damage of a vessel. It is observed during the operation to ensure tissue has maintained blood supply and also to preserve total blood volume. The strict aseptic technique involves taking precautions to ensure no infection to the tissue from the pathogens during a medical operation. SA thus applies the most rigorous rules to minimize any risk of infection, preventing any significant damage to tissue. Accurate tissue apposition is a technique that helps maintain minimum tension. It promotes healing and eliminates possible dead space that can delay healing.

There are four major types of tissues in the human body, namely epithelial, nervous, muscles, and connective tissues. Epithelial tissue is the outermost covering tissues in covering the body. They are made up of epithelial cells that take various forms like flat, cuboidal, or columnar that are together jointed to make a stacked continuous sheet that forms a perfect cover for the body. Such includes smooth muscles, skeletal, and cardiac muscle tissue.

Connective tissue is a web-like abundant Tissue in the body functioning to hold and support body parts together and support to other body organs.

Nervous tissue is found within the nervous system made up of specialized long and sting-like cells that receive and conduct stimuli to all parts of the body to effect a feeling of sense.

Muscle tissues are made up of long and fibrous continuous cells that contract and relax to effect a move in the body parts. They are categorized into three namely smooth, skeletal, and cardiac

What instrument(s) is appropriate for each type of tissue/organ found?

Transepithelial/transendothelial electrical resistance (TEER) measurement technology is best applied in measuring the epithelial tissue as it is susceptible and most reliable in measuring the permeability and integrity of a monolayer (Srinivasan et al, 2015). Amplifier and digitizers for Nervous tissues. Muscles tissues scalpel, scissors, forceps, clamps, needles, retractors, staplers, and clips. A microscope can be used during surgery to observe Connective tissues.

Desiccation is a state of dryness or process of removing moisture from a tissue. It can occur during surgical operations that involve bone discs. This occurs mainly among the elderly, causing the fluids within the discs to dry, resulting in stiffness, tingling sensation or numbness of the joints, and at times, painful movements.

Iatrogenic injury is often an auto-damage of a tissue or an organ resulting from the application of medical operation by a surgeon. Timely attendance of the iatrogenic injury or a resulting wound prevents infection and enhances healing. It is an expected situation as the majority of surgical involves dissection of tissues hence the wound.

Surgical misadventure is terrible results that occur during the operation despite the excellent and reasonable effort. It is never easy to resolve a situation and times life-threatening. The surgeon thus needs to be more careful to avoid such adverse scenarios.

Blanching/tissue necrosis is a death of tissue as a result of too little or no blood is flowing to the tissue following an injury or a traumatic injury.

Hemorrhage is a loss of blood after a vessel is damaged. It can be internal or external. SA working with the surgeon should respond urgently to prevent excess loss of blood by use available equipment.

Preoperative patient care is a preparation or an assessment done by an SA before major elective procedures and done to ensure that the patient qualifies to undergo surgery. SA informs the patients of the need for the operation, self, or the relatives’ signs the surgery consent forms. SA also identifies if the patients meet all the clinical assessments before surgery.

SA should make prior arrangements to prepare a room for operation or a theatre. It helps the surgeon to perform the surgery in a conducing environment where all the equipment and tools are set, and all other health teams have been assigned specific duties. Other preparations is to ensure room lighting and all electronic machines are working properly, aeration, and spacious to eliminate possible distraction during movement within the operation room.

Proper positioning of patients is important as it offers comfort during operation. Positioning can be supine, prone, lateral, Sims, Fowler’s Trendelenburg and tripod position as per the operation site (McCutcheon & Doyle, 2018).

There is wide range of local anesthetics medications commonly used in surgery. The intention is to prevent pain during surgery by making numb feeling on the surgical sites. Such includes the cocaine derivatives such bupivacaine, benzocaine, lidocaine, and novocaine. Menthol is also used though to provide relief.

Prior to making an incision, surgeon should select properly the execution site and infiltrate with local anesthetic in consideration of the duration of the surgery. It should be made parallel to the lines of skin tension (Langer’s line) by use of vertical scalpel blade. Should also remember the skin mechanism and its anatomy. Also, plan on the direction, shape and length of incision. Also, it is advisable to draw the incision out first be making it. Then use the other hand to assist stretch the skin, making it tighter and thus easier to cut and always away from our hands to eliminate unintentional injury.

Exposure Techniques is a physiological treatment or a therapy done to target patients introducing them to the anxiety source without the intention of causing danger or anxiety. The exposure helps the patients to overcome fear; distress that may arise when exposed to it, for example, is the patients awaiting medical operation or a person living with post-traumatic stress disorder (PTSD). When done, patients are prepared and advised accordingly. Techniques used help a person overcome their anxiety and related fear. Graded exposure is a gradual exposure to feared situations and step by step, learn to control and overcome their fear. Systematic desensitization is almost the same as graded exposure, but the individual also learns relaxation training methods to aid in combating the fear. Flooding technique is only used until the patient has reduced the anxiety and then flooded with feared stimuli at once. It is much quicker technique of t anxiety treatment, especially if it has a daily effect on individual lives. Prolonged exposures are mostly applied among patient who has a PTSD. During the disclosure, the patient is re-introduced to the experience in a controlled, safer manner treating the triggers or reminders that caused the trauma instead of avoiding them.

Needles used in surgical operations are designed to meet specialized applications and thus comes with various sizes, shapes, and types. Straight needles fit subcuticular suturing and skin, while curved needles are best suited in general surgical operations. Various types include:

Tapered needle, as suggested by name tappers to a simple point. It mostly applied in the surgical procedure of soft tissue like intestines. It can as well applied in tougher muscle tissues with additional pressure. Conventional Cutting Needle assumes a triangular shape with a shape curved cutting edge. It mostly used in tougher tissue such as skin and muscle tissues. Curved needle is another commonly used as it allows needle maneuvering and turnout from tissue than straight needles. Reverse cutting needles, also called spatula, are mostly applied in ophthalmic procedures as it enables needle to split through thin layers. Blunt point needles are majorly used in dissecting tissues like liver or kidney (Michael, 2017).

Wound closure techniques is an advancing section, and that requires adequate skills in handling of the wound. The primary intention of the injury is to facilitate the biological event of healing by joining separated edges. Joined tissue edges start remodeling and healing process.

Techniques used in wound closure are by use of staples, sutures, and adhesives(Waheed & Council, 2019). Staples are majorly utilized in the closing of minor wounds as they can be replaced easily and affordable with similar healing effectiveness as sutures. The use of Suture technique is the standard of the requirement of wound care. Sutures are of two types. That is absorbable and non-absorbable sutures. Non-absorbable are more common as do not alter with the natural wound healing process of the wound. It is mostly applicable on superficial wounds. Absorbable on the other hand, are placed in a double layer and offers little tension and closure of wounds edges. Adhesives like skin glues are used in wounds among the pediatric cases as they are painless when removing, have reduced inflammation, and lower risk of infection (Waheed & Council, 2019).

Multiple factors must be considered in the event of making it more cosmetic to minimize the risk of scaring. Surgeon or physicians, or dermatologist uses a variety of aesthetics that can be administered via injection and or painting on the surface without affecting the natural healing of the wound/skin. As SA, I can make the wound more cosmetic by prescribing petrolatum ointments or antibiotic ointments that reduce the risk of infection.

In summary, the Surgical Assistant plays a vital role in the Intraoperative Surgical procedures hence affecting the outcome of any surgery.  SA should be competent, calm, courageous, and knowledgeable of all the operations and should demonstrate steadfast during surgery. They should also able to perform general surgical procedures including patient and operating preparation, types of tissues in the human body, handling techniques and equipment best suited to handle it to improve the surgical outcomes. During surgery, SA should also focus on assisting in eliminating potential complications and injuries. Proper positioning of patients is crucial as it offers comfort during operation. Local anesthesia is used to combat pain during surgery. Patient preparation before surgery helps overcome fear related to the idea of undergoing surgery. For better surgical outcomes, SA should have basic skills in wound management and type of materials to be used to hasten wound healing.

References

1. Allen, P. (2016). Surgical Assisting—Duties during Surgery. Small Animal Surgical Nursing-E-Book, 119.
2. Harry W. B., (2016). Instrument and Tissue Handling Techniques. Retrieved 25 March 2020, from https://veteriankey.com/instrument-and-tissue-handling-techniques/
3. McCutcheon, J. A., & Doyle, G. R. (2018). Clinical Procedures for Safer Patient Care.
4. Michael, V. (2017). Commonly Used Surgical Instruments. Retrieved 25 March 2020, from https://www.facs.org/-/media/files/education/medicalstudents/common_surgical_instruments_module.ashx/
5. Srinivasan, B., Kolli, A. R., Esch, M. B., Abaci, H. E., Shuler, M. L., & Hickman, J. J. (tt TEER measurement techniques for in vitro barrier model systems. Journal of laboratory automation, 20(2), 107-126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652793/
6. Waheed, A., & Council, M. (2019). Wound closure techniques. In StatPearls [Internet]. StatPearls Publishing.