Lesson 1Intraoperative counts: baseline, intermittent, and closing counts for instruments, needles, and spongesDetails standard intraoperative counts for instruments, needles, and sponges, including initial, ongoing, and final counts, records, mismatch handling, and legal aspects for the scrub team in Zimbabwe.
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 devicesReviews main laparoscopic instruments for appendectomy, covering names, uses, assembly, safe passing, and upkeep, so scrub staff can foresee surgeon needs and avoid device issues.
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 techniquesExamines trocars and ports in appendectomy, including types, sizes, valve styles, safe insertion order, site choice, fixing ways, and steps to reduce gas leaks 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 labeling for pathologyExplains safe handling of appendiceal specimens, including endobag loading, port retrieval, contamination avoidance, proper labeling, records, and pathology coordination 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 artifactsCovers camera and image handling, including lens assembly, white balance, focus, defogging, cleaning methods, cable routing, and fixing fogging, smearing, and color or 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 stepsPrepares staff for equipment breakdowns during surgery, like camera, insufflator, and ESU issues, using step-by-step checks, backups, and clear escalation to surgeon and support teams.
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 requestsBuilds strong communication with surgeon and anesthesia, focusing on closed-loop talks, need prediction, key change sharing, and calm, united teamwork under stress in the OR.
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 leaksExplains insufflation control during surgery, including CO2 setup, flow and pressure settings, abdominal pressure monitoring, leak or emphysema spotting, and 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 perspectiveOutlines laparoscopic appendectomy steps from scrub view, stressing prep, trocar order, exposure, appendix control, division, retrieval, and closure, foreseeing instruments per 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 managementAddresses safe energy device use, like bipolar, monopolar, and ultrasonic tools, focusing on connector checks, insulation, activation safety, tissue effects, and smoke clearing 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
