Mastering First Assist in Surgery for APPs: Tips & Techniques

Foundational Principles for Surgical Assisting

• 💡 Know your anatomy specific to the case and understand the surgeon's goal for the procedure to be an active participant.
• 🎯 Prepare thoroughly by going to the OR early, having films ready, and organizing admission orders to ensure a smooth workflow.
• 🔑 Understand and adapt to your surgeon's preferences and their specific way of running a case, keeping a running list if working with multiple surgeons.
• ⚡ The core principle of tension and counter-tension is crucial for creating clear planes for dissection, especially when working with tissue.
• 🧠 Be ready for the surgeon's needs, such as preparing scissors for suture cutting or offering a 'follow' to manage excess suture material.
• ⚠️ Learn to read the room and know when to stay out of the way, as sometimes providing space is more helpful than leaning in.

Laparoscopic and Robotic Surgery Assistance

• 🚀 When piloting the camera in minimally invasive surgery, maintain a steady horizon, understand the equipment (scope size, degree), and master focus, white balance, and zoom.
• 🔍 Use external anatomical cues and the scope's angle to guide instrument placement, avoiding surprises for the surgeon and preventing damage to critical anatomy.
• 📌 When bringing in sutures, grab the suture an inch away from the needle and avoid changing direction through the trocar to prevent losing the needle.
• 🧩 Robotic surgery requires a solid understanding of the equipment, proper docking, arm spacing (about a foot apart), and correct trocar depth.
• 💬 Closed-loop communication is paramount in robotic surgery, especially when there's any doubt about instrument or arm usage, to ensure patient safety and team coordination.

Training and Development for APPs in Surgery

• 🩺 NP students may need to actively seek out surgery rotations and formal training, including O etiquette and scrubbing, as it's not always a standard part of their curriculum.
• 🛠️ Consider pursuing additional training like an RN First Assist (RNFA) program for structured skill development, especially if formal first assist training isn't mandated.
• 🌱 Seek out opportunities to assist as a student to build comfort and add value by learning skills like following, tracking, and hand-tying.
• 🤝 It's okay not to know everything initially; asking surgeons for guidance on how to help them (