Lesson 1Intraoperative counts: baseline, intermittent, and closing counts for instruments, needles, and spongesThis section details standardised intraoperative counts for instruments, needles, and sponges, covering baseline, intermittent, and closing counts, documentation, discrepancy management, and legal implications for the 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 devicesThis section reviews core laparoscopic instruments used in appendectomy, focusing on names, functions, assembly, safe passing, and maintenance, so scrub staff can anticipate surgeon needs and prevent device-related complications.
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 section reviews trocars and ports used in appendectomy, covering types, sizes, valve designs, safe insertion sequence, port site selection, fixation methods, and strategies to minimise 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 labelling for pathologyThis section explains safe appendiceal specimen handling, including endobag loading, retrieval through ports, avoiding contamination, correct labelling, documentation, and coordination with pathology to preserve 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 artefactsThis section covers camera and image management, including lens assembly, white balance, focus, defogging, cleaning techniques, cable routing, and troubleshooting fogging, smearing, and colour or brightness artefacts.
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 section prepares 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 anaesthesia: closed-loop communication, anticipating requestsThis section develops effective communication skills with surgeon and anaesthesia, emphasising closed-loop communication, anticipation of needs, sharing critical changes, and maintaining 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 leaksThis section explains insufflation management, including CO₂ setup, flow and pressure settings, monitoring intra-abdominal pressure, recognising leaks or subcutaneous emphysema, and coordinating adjustments with anaesthesia 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 perspectiveThis section outlines laparoscopic appendectomy steps from the scrub perspective, emphasising 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 managementThis section addresses safe use of energy devices, including bipolar, monopolar, and ultrasonic tools, with emphasis on 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
