A Surgeon’s Point of View

By Dr. John Stulak, MD, Cardiovascular Surgeon, Mayo Clinic

The certified surgical assistant is a position that is quite unique to the surgical specialty, especially as most institutions utilize physician assistants (PA) or registered nurse first assistants (RNFA). Yet the history and importance of surgical assistants at Mayo Clinic, as well as other institutions, cannot be overstated.

At my institution, the stability of Mayo Clinic typically results in staff surgeons spending an entire career at the institution, and similarly, surgical assistants have historically remained in their position, as well. This consistency throughout a career also cannot be overstated.

I am currently a consultant in the department of cardiovascular surgery, and I performed all of my general surgery and cardiac surgery training at the Mayo Clinic. My first experience with the surgical assistant was during general surgery training. During these years, it was not uncommon to encounter assistants who had worked with their surgeons for more than 20 years. This resulted in an individual who knew every intricacy of the staff surgeon’s work. The surgeons were comfortable with their surgical assistants, and because of this, they would let the two of us start operations and then close up at the end. The trust they had in their surgical assistants was astounding and clearly well earned. The surgical assistants kept me out of trouble many times and taught me a tremendous amount about operations, surgical technique and the Mayo Clinic surgical culture. 

When I progressed to cardiac surgical training, the importance of the surgical assistant was paramount due to the high acuity of patients in this specialty. In many instances, the foundations of cardiac surgery were taught to me by the surgical assistant, again reflecting the staff surgeon’s immense trust of the surgical assistant. I remained very open to feedback, instruction and education by these knowledgeable individuals. They did far more than simply “assist” during the case. From a trainee’s perspective, they are, in many ways, one of the primary educators during this very stressful time.

Once I transitioned to being a consultant, the role of the surgical assistant grew even more. The evolution from trainee to consultant is a very stressful one, and facing tough cases are consistently made so much easier when I am working with my surgical assistant. Surgical assistants’ experience of how to expose the area I need to see, maintain the flow of the operation and give their insights, instantly calm very intense situations. I appreciate the entire spectrum of their role and their importance. To this day, a stressful case is eased knowing I have my surgical assistant there as a security blanket.

For the aspiring surgical assistant, my advice is to be humble, accept feedback and embrace new opportunities to learn. The operating room, surgeons and sick patients can contribute to a high-stress environment, but despite this, always view the opportunity to scrub as a privilege — and always do what is best for the patient. 

Read more in the series here:
Safety in Numbers: The Power of Surgical Technologists in the Operating Room
The Critical Role of Surgical Technologists and Surgical Assistants