Lesson 1Intraoperative counts: baseline, intermittent, and closing counts for instruments, needles, and spongesDis section detail standard intraoperative counts for instruments, needles, and sponges, covering baseline, intermittent, and closing counts, documentation, managing discrepancies, and legal implications for scrub team.
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 devicesDis section review core laparoscopic instruments used in appendectomy, focusing on names, functions, assembly, safe passing, and maintenance, so scrub staff can predict surgeon needs and prevent device problems.
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 techniquesDis section review trocars and ports used in appendectomy, covering types, sizes, valve designs, safe insertion sequence, port site choice, fixation methods, and ways to minimize gas leaks and port-site injury.
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 labeling for pathologyDis section explain safe appendiceal specimen handling, including endobag loading, retrieval through ports, avoiding contamination, correct labeling, documentation, and coordinating with pathology to keep diagnostic quality.
Endobag selection and preparationLoading the appendix into the endobagExtraction through ports without spillageHandling suspected perforated specimensLabeling, requisitions, and identifiersChain of custody and documentationLesson 5Camera and image management: lens cleaning, focus, white balance, troubleshooting image artifactsDis section cover camera and image management, including lens assembly, white balance, focus, defogging, cleaning techniques, cable routing, and fixing fogging, smearing, and color or brightness artifacts.
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 stepsDis section prepare staff to respond to intraoperative equipment failures, including camera, insufflator, and ESU problems, using systematic checks, backup devices, and clear escalation to surgeon and biomedical support.
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 anesthesia: closed-loop communication, anticipating requestsDis section develop effective communication skills with surgeon and anesthesia, stressing closed-loop communication, anticipating needs, sharing critical changes, and keeping calm, coordinated teamwork under pressure.
Principles of closed-loop communicationStandard phrases for critical eventsAnticipating surgeon instrument needsSharing hemodynamic or airway concernsManaging distractions and noise levelsDebriefing and feedback after the caseLesson 8Insufflation management during case: flow, pressure adjustments, addressing subcutaneous emphysema or leaksDis section explain insufflation management, including CO₂ setup, flow and pressure settings, monitoring intra-abdominal pressure, spotting leaks or subcutaneous emphysema, and coordinating adjustments with anesthesia and surgeon.
Insufflator checks and tubing connectionsSetting initial pressure and flow ratesMonitoring intra-abdominal pressure trendsDetecting and managing gas leaksRecognizing subcutaneous emphysema signsCommunication with anesthesia on pressuresLesson 9Standard procedural steps of laparoscopic appendectomy from scrub technician perspectiveDis section outline laparoscopic appendectomy steps from scrub view, stressing preparation, trocar sequence, exposure, appendix control, division, retrieval, and closure while anticipating instruments at each phase.
Preoperative setup and instrument layoutTrocar insertion and initial explorationExposure of cecum 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 managementDis section address safe use of energy devices, including bipolar, monopolar, and ultrasonic tools, stressing connector checks, insulation integrity, activation safety, tissue effects, and smoke evacuation practices.
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
