Orthopaedic surgery

Orthopaedic surgery is a team effort

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Guest post by Jessica Scott, PA-C, OU Medical Center Edmond

A surgical procedure, whether an outpatient surgery such as rotator cuff repair or a larger procedure such as total shoulder replacement, is very much a team effort. Here are a few of the key players in surgery, some of whom patients will meet and others whom they will not.

Pre-Operative Nurse

When a patient arrives at the hospital, a pre-op nurse will ensure they are checked in and prepared for surgery. This includes placing an IV, asking questions about health history and current medications, and other steps to prepare the patient for their procedure.

Circulator Nurse

The circulator nurse is in the operating room to document what happens during surgery, including what time the patient entered the room, when the incision was made, and any other details. The circulator nurse is not sterile, so if the surgical team needs something from outside the sterile field or outside the operating room, the circulating nurse can go get it. This is also the nurse who updates the patient’s friends or family in the waiting room about how surgery is going.


The anesthesiologist is responsible for putting the patient to sleep and controlling their pain for the procedure. They are in the room throughout the procedure to monitor the patient’s vitals, ensure they stay asleep, and help control any pain during the procedure. If the procedure is being done with a regional block, the anesthesiologist places the block prior to the procedure.

Primary Surgeon

For patients of the Oklahoma Shoulder Center, Dr. Betsy Nolan is the primary surgeon. The primary surgeon is responsible for the majority of the surgical procedure.

First Assist

The first assist is usually a resident surgeon or a physician’s assistant. Their role in surgery is to provide support in whatever way the surgeon requests support, such as holding retractors or doing suction so the surgeon can see better. The first assist also acts as another set of eyes and ears for the surgeon. They play an important role in positioning of the patient. As the surgeon focuses on a particular task, it is the first assist’s job to survey everything else happening and do what’s necessary to support the surgeon.

In many cases, the PA and/or resident also assists with taking care of the patient postoperatively if a stay in the hospital is necessary.

Scrub Techs

Scrub techs are another part of the surgeon’s support team. They assist with retraction, handing instruments to the surgeon, or anything else needed during the procedure.

Device Company Representative

For surgeries that will use an implant of some kind, a representative from the device company is also present. The representative will unpack the boxes to ensure everything meets the company’s specifications and be available to answer any specific questions related to the company’s implant or instruments.

Post-Operative Nurses & Techs

After surgery, a team of nurses and techs will care for the patient on the floor. Nurses will administer meds and monitor pain levels, nausea, and other postoperative symptoms to ensure the patient stays comfortable while recovering. Techs assist with activities like toileting and bathing, as well as checking vital signs.

X-Ray Tech

For some procedures, x-ray is required during the procedure in order to check, for instance, fracture alignment or hardware placement. An x-ray tech with a mobile x-ray machine called a c-arm comes into the operating room to take x-rays when requested by the surgeon.

Additional Support Roles

Aside from the team members directly involved in surgery and pre/post-operative care, there are additional support staff members often working behind the scenes. This category includes schedulers, medical coders, billing department staff, and hospital administrators, all of whom help ensure a smooth process for patients.

While a patient will mostly see their surgeon and pre/post-op nurses, it takes the entire team to ensure a successful surgery.