Lesson 1Anticipating surgeon needs at key operative stages: exposure of Calot’s triangle, identification of cystic duct and artery, clipping and division, gallbladder dissection and retrievalFocuses on anticipating surgeon needs during key stages: gaining exposure, dissecting Calot’s triangle, identifying cystic structures, clipping and dividing, and assisting with gallbladder dissection, retrieval, and specimen handling during surgery.
Instrument needs for initial exposureSupport during Calot’s triangle dissectionPreparation for clipping and divisionAssisting gallbladder dissection stepsSpecimen retrieval and bag handlingLesson 2Communication and closed-loop technique in theatre: assertive communication, calling out counts, reporting unexpected findings, speaking up about safety concernsCovers structured communication in theatre, emphasising closed-loop technique, assertive but respectful language, calling out counts and critical steps, escalating unexpected findings, and voicing safety concerns without hesitation in team settings.
Principles of closed-loop communicationStandardised calls for key stagesCalling and confirming instrument countsEscalating unexpected intraoperative findingsSpeaking up about safety concernsLesson 3Instrument handling and passing principles: neutral zone, finger-ring technique, one-hand vs two-hand passes, ergonomic positioningDetails safe handling and passing of laparoscopic instruments, emphasising neutral zone use, finger-ring control, one-hand versus two-hand passing, ergonomic posture, and strategies to reduce fatigue and sharps or crush injuries in theatre.
Neutral zone setup and use in laparoscopyFinger-ring and hand grip controlOne-hand versus two-hand instrument passesErgonomic posture at the scrub trolleyPreventing sharps and crush injuriesLesson 4Use of energy devices and smoke management: bipolar/monopolar diathermy, ultrasonic devices, plume evacuation protocols and PPECovers safe use of monopolar, bipolar, and ultrasonic energy, including setup, activation safety, prevention of stray burns, and effective smoke evacuation with appropriate PPE to reduce plume exposure risks for the team in Zambian theatres.
Monopolar and bipolar diathermy setupUltrasonic device indications and checksActive electrode and cable safetySmoke evacuation systems and settingsPPE for surgical plume exposure controlLesson 5Managing intraoperative sterility breaches and complications: immediate actions for gown/glove breach, contamination of instruments, suspected bile leak or hemorrhage, calling for senior helpAddresses recognition and management of sterility breaches and intraoperative complications, including gown or glove tears, contaminated instruments, suspected bile leak or bleeding, and timely escalation to senior staff and documentation in practice.
Detecting gown and glove breachesResponding to contaminated instrumentsActions for suspected bile leakInitial response to intraoperative bleedingEscalation pathways and documentationLesson 6Sharps handling and safety devices: needle handling, sharps counters, use of safety scalpels and blunt needles, immediate disposal protocolsOutlines safe sharps handling in laparoscopy, including needle loading, use of sharps counters, safety scalpels and blunt needles, neutral zone passing, and immediate disposal protocols to minimise needlestick and cut injuries during procedures.
Sharps risk assessment in laparoscopyNeedle loading and unloading safelyUse of sharps counters and traysSafety scalpels and blunt needle useImmediate sharps disposal protocolsLesson 7Patient positioning and pressure area protection: supine/tilt considerations, securing the patient, padding, table tilt for exposureExplores safe supine and tilt positioning for laparoscopic cholecystectomy, including securing the patient, protecting pressure areas, optimising table tilt for exposure, and monitoring for physiological compromise during position changes in theatre.
Supine and reverse Trendelenburg principlesSecuring the patient and limb supportsPressure area assessment and paddingTable tilt for optimal surgical exposureMonitoring hemodynamic and respiratory effectsLesson 8Trocar insertion assistance and safe insufflation: sequencing of ports, Veress vs open/Hasson technique overview, insufflation pressures and monitoringReviews assistance with trocar insertion and pneumoperitoneum, including port sequencing, Veress versus open techniques, safe insufflation pressures, monitoring patient response, and troubleshooting alarms or gas leaks in laparoscopic procedures.
Port site planning and sequencingAssisting Veress needle insertionAssisting open or Hasson entryInsufflation pressures and flow ratesMonitoring for gas leaks and alarmsLesson 9Skin preparation and draping for laparoscopic cholecystectomy: antiseptic choice and technique, timed drying, adhesive drapes, port site positioning and protection of non-sterile areasDescribes skin preparation and draping specific to laparoscopic cholecystectomy, including antiseptic selection, prep technique, drying times, adhesive drapes, port site marking, and protection of non-sterile areas from fluid strike-through in Zambian practice.
Antiseptic agent choice and allergiesSystematic abdominal prep techniqueTimed drying and fire risk reductionDrape selection and adhesive sealingPort site marking and access windowsLesson 10Establishing and maintaining the sterile field: sterile field setup, transfer of sterile items, maintaining distance, monitoring for breachesExplains establishing and maintaining a safe sterile field, including layout of laparoscopic instruments, transfer of sterile items, maintaining appropriate distance from non-sterile areas, and continuous monitoring for contamination or breaches during surgery.
Sterile field layout for laparoscopyOpening and transferring sterile itemsMaintaining distance from non-sterile zonesIdentifying and managing field breachesDocumentation of contamination events
