Assisting in Surgical Theatre 101: The beautiful complexity of a hernia repair

Assisting in the surgical theatre is a tricky business, so in this blog I’m going to be talking about my three key takeaways to someone new to the environment.

The first time I was able to assist on a paediatric surgery operation was pure coincidence.

In one theatre, the SHO, registrar and consultant were involved in a complex procedure from which none of them could be torn. In the adjacent theatre, another registrar was preparing for an inguinal hernia repair. The patient was a 6-year-old who had been seen in clinic with a indirect inguinal hernia (the type that protrudes through the inguinal canal).

Understanding of the inguinal canal, and the myriad of hernias that occur in its proximity, is one of the keystones of surgical anatomy that all medical students are taught over and over again. To a surgical registrar, I’m sure it may be considered one of the more banal procedures, especially in paediatric surgery when the operating list can range anywhere between operating on a 24-week gestation neonate with an abdominal wall defect, to a 17 year old with an ovarian cancer. For me, however, this was incredibly exciting because I was assisting.


Figure 1. The difference between a direct and indirect inguinal hernia: one of the keystones of medical school surgical anatomy. Drawn by me.


In real time, I had the chance to watch as this anatomy was revealed, as the complexity of the inguinal canal was laid open before my eyes. I was shown how to hold the protractor properly to demonstrate the vas deferens and vessels in all their glory, and I watched as the defect was thoroughly sewn shut to avoid recurrence. Simple as written here, but delicate in practice. The takeaway from all this? Anatomy is awesome, and surgery is the perfect medium in which to demonstrate it!

But surgery is also so much more than the procedure being undertaken. It’s about the entire surgical environment. It’s about communicating openly with the entire operating team, and working together. As a medical student, there are always so many questions running through my head when I’m in the operating theatre. It can sometimes seem a minefield of etiquette.

Should I stand here?

Or here?

Will I be able to see anything?

Am I going to be allowed to scrub?

Is it even useful to be scrubbed in for this procedure?

On this occasion, fortunately I already knew the team. The registrar told me just where to sit, and where to put my hands to best preserve the sterile field. My advice for any medical student wanting to make the most of their time in the theatre is that it’s always good to ask whenever you’re unsure. If the surgeons are busy you can talk to the scrub or anaesthetics team. There will be plenty that you don’t know, and that’s absolutely fine.

My first day in an operating theatre ever, I bumped a sterile light cover with my theatre cap, rendering it non-sterile. I mentioned it immediately to the scrub nurse, who arranged to change the cap, and alerted the rest of the team. At the time, I didn’t appreciate the significance of what had happened, but that was understandable. I was honest, and I learnt from it.

My final takeaway, and perhaps the most important, is simply to enjoy the experience! As a medical student, your foremost job in the operating theatre is to learn. You don’t have a bleep to answer, or a ward job to which you need to return. Partake however you can, whether that’s just watching from the back (which can actually be much more fruitful than being scrubbed if the procedure involves a camera), or in doing simple manual skills such as cutting sutures or holding equipment. If you’re lucky, you might even be able to put in your own sutures or tie a knot.

To summarise, here are my top tips for making the most out of your operating theatre experience!

  1. Take the chance to learn the anatomy. Ask questions, especially if you don’t have a good view.

  2. Ask for something to be explained if you don’t understand. They don’t expect you to know everything: your job as a medical student is to learn.

  3. Above all, enjoy it! Help however you can, no matter how small the job: cut sutures, hold retractors, help with the suctioning or cleaning.

Author

Laura Wilkins - SUTURE UK May Blog Competition Winner



Laura Wilkins is a medical student at the University of Oxford, with an interest in paediatric surgery.


Laura can be found on Twitter @Dr_LauraW.