Lesson 1Intraoperative counts: baseline, intermittent, and closing counts for instruments, needles, and spongesThis lesson details routine intraoperative counts for instruments, needles, and sponges, including initial, ongoing, and final tallies, recording, mismatch handling, and implications for scrub teams in ensuring no items are left behind.
Baseline count setup and role divisionIntermittent counts during critical stepsClosing counts before trocar removalDocumentation in the operative recordManaging count discrepancies and searchUse of adjunct technologies for countsLesson 2Common laparoscopic instruments: graspers, dissectors, scissors, bipolar/monopolar instruments, specimen retrieval devicesThis lesson reviews standard laparoscopic tools for appendectomy, covering names, purposes, assembly, safe transfer, and upkeep, enabling scrub staff to foresee surgeon requirements and avoid device issues during surgery.
Graspers and atraumatic bowel handlingDissectors and blunt versus sharp tipsLaparoscopic scissors and safe cuttingMonopolar and bipolar instrument setupSpecimen retrieval bags and loadersInstrument inspection and troubleshootingLesson 3Trocars and ports: types, sizes, placement sequence, and securement techniquesThis lesson examines trocars and ports in appendectomy, including varieties, dimensions, valve types, insertion order, site choices, fixing approaches, and methods to curb gas escapes and site injuries.
Bladed versus bladeless trocar designsPort sizes and typical appendectomy layoutSafe trocar insertion and anglesPort site selection and ergonomicsSecuring ports to prevent dislodgementManaging port-site gas leaksLesson 4Specimen handling and retrieval (endobag use) and labelling for pathologyThis lesson instructs on secure appendiceal specimen management, using endobags for loading and port extraction, preventing spills, proper labelling, records, and pathology coordination to retain sample integrity.
Endobag selection and preparationLoading the appendix into the endobagExtraction through ports without spillageHandling suspected perforated specimensLabelling, requisitions, and identifiersChain of custody and documentationLesson 5Camera and image management: lens cleaning, focus, white balance, troubleshooting image artifactsThis lesson addresses camera and image control, including lens setup, white balance, focusing, defogging, cleaning, cable paths, and fixing issues like fog, smears, or colour/brightness problems.
Camera head and telescope assemblyWhite balance and focus techniquesAnti-fogging and lens warming methodsSafe lens cleaning during the caseCable management and strain reliefTroubleshooting image artifactsLesson 6Immediate responses to intraoperative equipment failure (camera, insufflator, ESU) and escalation stepsThis lesson readies staff for equipment breakdowns like camera, insufflator, or ESU faults, using step-by-step checks, spares, and alerts to surgeons and support for quick resolution.
Structured approach to device failureCamera blackout and poor image responseInsufflator alarms and loss of pneumoperitoneumESU malfunction and alternative optionsSwitching to backup equipment safelyEscalation and documentation of incidentsLesson 7Effective communication with surgeon and anaesthesia: closed-loop communication, anticipating requestsThis lesson builds communication prowess with surgeons and anaesthesia, using closed-loop methods, need prediction, vital updates, and steady teamwork to handle pressure in theatre.
Principles of closed-loop communicationStandard phrases for critical eventsAnticipating surgeon instrument needsSharing haemodynamic or airway concernsManaging distractions and noise levelsDebriefing and feedback after the caseLesson 8Insufflation management during case: flow, pressure adjustments, addressing subcutaneous emphysema or leaksThis lesson covers insufflation oversight, with CO2 arrangements, flow/pressure settings, abdominal pressure tracking, leak or emphysema detection, and team adjustments for stability.
Insufflator checks and tubing connectionsSetting initial pressure and flow ratesMonitoring intra-abdominal pressure trendsDetecting and managing gas leaksRecognising subcutaneous emphysema signsCommunication with anaesthesia on pressuresLesson 9Standard procedural steps of laparoscopic appendectomy from scrub technician perspectiveThis lesson maps laparoscopic appendectomy phases from the scrub view, covering prep, trocar placement, exposure, appendix handling, division, retrieval, and closure with tool anticipation.
Preoperative setup and instrument layoutTrocar insertion and initial explorationExposure of caecum and appendixSecuring and dividing the mesoappendixAppendiceal base ligation and divisionFinal inspection, suction, and port closureLesson 10Use and safety of energy devices: bipolar forceps, monopolar hooks, ultrasonic shears — connector checks and smoke managementThis lesson tackles safe energy device application, including bipolar, monopolar, and ultrasonic types, with connector verifications, insulation, activation safety, tissue impacts, and smoke control.
Pre-use inspection and connector checksMonopolar setup and return electrode safetyBipolar forceps use and limitationsUltrasonic shears handling and carePreventing stray energy and burnsSmoke evacuation and filter use
