CSFA Intraoperative Surgical Procedures 5 — Questions and Answers
Question 1: The surgical first assistant notices a sponge count discrepancy at wound closure. The most appropriate action is to:
- Close the incision and rely on radiology postoperatively
- Inform the surgeon immediately, halt closure, and search the wound and field before closing (Correct answer)
- Document the discrepancy and proceed
- Recount only the instruments
Correct answer: Inform the surgeon immediately, halt closure, and search the wound and field before closing
A retained surgical item is a sentinel event; closure must be halted and a thorough search conducted before the wound is closed.
Question 2: During a spinal fusion procedure, the surgical first assistant is asked to apply bone wax. Its primary purpose is:
- Antimicrobial coverage of the exposed bone
- Mechanical hemostasis of bleeding cancellous bone surfaces (Correct answer)
- Promotion of osteogenesis
- Fixation of spinal hardware
Correct answer: Mechanical hemostasis of bleeding cancellous bone surfaces
Bone wax physically occludes the haversian canals of cancellous bone to mechanically control bleeding from cut bony surfaces.
Question 3: During a cesarean section, the surgical first assistant assists with uterine closure. Which suture configuration is most commonly used for the uterine incision?
- Running locking suture in a single layer only
- Two-layer closure with running absorbable suture (Correct answer)
- Interrupted silk sutures
- Figure-of-eight permanent suture
Correct answer: Two-layer closure with running absorbable suture
A two-layer running absorbable closure of the uterine incision provides secure hemostasis and reduces the risk of uterine rupture in future pregnancies.
Question 4: When a laparoscopic trocar is inadvertently placed into a major abdominal vessel, the surgical first assistant's first priority is:
- Remove the trocar immediately to release pressure
- Leave the trocar in place to tamponade the vessel and call for immediate open conversion assistance (Correct answer)
- Apply topical hemostatic agents through the trocar
- Increase pneumoperitoneum pressure to 30 mmHg
Correct answer: Leave the trocar in place to tamponade the vessel and call for immediate open conversion assistance
Removing a trocar from a vessel removes the tamponade effect and causes uncontrolled hemorrhage; leaving it in buys time for emergency conversion.
Question 5: During orthopedic surgery, pulsatile lavage irrigation is used primarily to:
- Sterilize the wound with chemical agents
- Mechanically debride and reduce bacterial counts in the surgical site (Correct answer)
- Accelerate bone healing
- Improve visualization by flooding the field
Correct answer: Mechanically debride and reduce bacterial counts in the surgical site
Pulsatile lavage uses pressurized fluid to mechanically dislodge debris, necrotic tissue, and bacteria from the wound.
Question 6: The surgical first assistant is managing a Bookwalter retractor system. To prevent neuropraxia, which precaution is essential?
- Tighten all blades to maximum tension immediately
- Ensure blades are not pressing on peripheral nerves, especially the femoral nerve in pelvic cases (Correct answer)
- Use only metal blades regardless of tissue type
- Set the ring as low as possible in the wound
Correct answer: Ensure blades are not pressing on peripheral nerves, especially the femoral nerve in pelvic cases
Rigid retractor blades can compress the femoral nerve at the psoas margin in pelvic surgery, causing postoperative neuropraxia if not carefully positioned.
Question 7: When assisting with a skin graft harvest using a dermatome, the surgical first assistant should apply counter-traction by:
- Pressing firmly on the dermatome blade
- Stretching the skin taut ahead of the advancing dermatome blade with a tongue depressor or gloved hand (Correct answer)
- Releasing the skin immediately after the blade contacts it
- Applying lubricant behind the dermatome
Correct answer: Stretching the skin taut ahead of the advancing dermatome blade with a tongue depressor or gloved hand
Adequate counter-traction ahead of the dermatome blade keeps the skin taut, ensuring a uniform, consistent split-thickness graft.
CSFA Intraoperative Surgical Procedures 5
The surgical first assistant notices a sponge count discrepancy at wound closure.
The most appropriate action is to: