Assistant Surgeon

Part of our junior surgery class is participating in live spay and neuter surgeries, usually working under 4th year students who are currently taking the shelter medicine rotation. We have to do about 12 surgeries total; 6 as an anesthetist, 3 as an assistant surgeon, and 3 as the primary surgeon. I'm not going to lie, I was pretty nervous. I had my surgeries scheduled before I even finished my cadaver surgeries, and I was not at all confident that one spay would prepare me to be an assistant surgeon. I couldn't even do my neuter, because my dog came already neutered. Not the best situation help with confidence levels.

But I have now completed all three of my assistant surgeon roles in live surgery. And while I had something pretty close to a panic attack before my first one, looking back I really enjoyed them. I learned way more from the live surgeries than I ever could have from the cadaver labs, and my confidence shot way up. Usually my 4th year primary surgeon let me do about a third of the procedure, such as removing one testis, or tying the Miller's Knot around the uterine body and transecting the uterine body. I didn't even learn the Miller's Knot until the live surgeries, even though that's all they use. I also learned how to do an instrument tie, although I'm not quite as proficient at that yet. I'll need to practice that.

With every surgery, I always feel like the beginning is just a huge mass of confusion. The anesthetists are trying to figure out what instruments need to be gathered for the catheter and endotracheal tube placement, the assistant surgeons are gathering gowns and surgery packs and gloves for the actual surgery, and I have no idea what the primary surgeons are getting ready. The beginning always feels like no one knows exactly what we should be doing. But then once we move to actually operate, I feel like everything always calms down. Anesthesia is all hooked up and only has to monitor, and the surgeons just kind of do their thing. And occasionally there is some excitement if the anesthesia gets a little light- usually it took took too long to actually begin the surgery and the anesthetic shot we give in induction is wearing off- but that has been the only wrench I've encountered so far. Knock on wood.

For the assistant surgeon role, the main job is obviously to assist the primary surgeon. This means that I would be responsible for doing the physical exams on the patients first, to make sure they are actually healthy enough for surgery. Then some of the patients get different shots with us too- some get rabies, some get distemper, some even get microchipped. I get to do all of that, and record where they shots were give to watch for an injection site reaction. Then after the patient has been induced and intubated by anesthesia, I prep the surgery site. So I clip the hair and perform a primary sterile scrub with chlorhexidine. Once the patient has been moved onto the operating table, I do a secondary sterile scrub. Then I go scrub in while the primary surgeon drapes the patient.

During the surgery, the only guidelines are to do whatever the primary surgeon asks for. Usually this involves handing over instruments, holding things out of the way such as mosquito clamps holding tissue, or helping keep suture tight. As I mentioned earlier, if the surgery is going well and appears to be uncomplicated, I have also been able to perform actual pieces of the surgery. On my second surgery as assistant surgeon I exteriorized a testis, stripped down all the spermatic fascia, clamped, sutured, and cut the spermatic cord. I learned so much more from doing this one testis than I did from anything in the cadaver lab. It may seem obvious, but dead animals don't bleed, and live animals bleed a lot. So you don't get that experience of looking and checking for hemorrhage and looking for structures through blood until you actually do a live surgery. The experience is really invaluable.

Then after the surgery, the people responsible for anesthesia stay with the patients until they wake up. You have to watch for the first attempt to swallow, and that is when it is safe to remove the endotracheal tube, but you always have to check for reflux to make sure nothing goes back down to the lungs that shouldn't. If the patients don't recover in time (our animals are all from local shelters, so they are picked up to be taken back to the shelters at a specific time) it is the assistant surgeon that stays with them and is responsible for coming in that night and the next morning to check on them and write the SOAP. The SOAP is basically just how the dog is doing- you have your subjective and objective observations, your assessment, and your plant of action. If the dog appears painful on a check up we take them up to ICU for some pain meds. Luckily, since spays and neuters are elective surgeries (for the most part), the animals are usually in pretty good health and there aren't any serious complications. I had one dog that was slow to wake up and her body temperature just would not come up after surgery. She ended up staying the night, but she wasn't painful and while her temperature was still lower than average the next morning, it was higher than it had been the night before and her attitude and demeanor was much better and much more lively. So there is a lot more that matters than just textbook ranges.

Now that I'm done with my assistant surgeries, I am moving on the my three surgeries as the primary surgeon over the next two weeks. I'm not as nervous as I was for my first surgery as the assistant surgeon, but I'm still a little nervous to have all of that responsibility on me. At least now though I feel like I have a much better idea of what to do and how to do it. I just need to practice my interdermal suture closure before then.