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Surgical First Assistant

Surgical First AssistantSurgical First Assistants are registered healthcare professionals who provide continuous competent and dedicated assistance under the direct supervision of the operating surgeon throughout the procedure, whilst not performing any form of surgical intervention. Read a real-life case study, written by a Surgical First Assistant.

Did you know that Surgical First Assistants are now eligible to join the RCS as associate members? As an associate member, you will be able to access a range of valuable benefits and access a 50% discount on membership during 2018. Find out more and join today.

Area of practice

Primarily intra-operative work, although pre- and post-operative visits may also be part of the role. 

Overview of tasks and activities

  • Enhancing the communication link between theatre, patient and ward
  • Involvement in the team completion of the WHO surgical safety checklist for all surgical interventions
  • Male urethral catheterisation
  • Assistance with patient positioning, including tissue viability assessment
  • Skin preparation prior to surgery and draping
  • Use and maintenance of specialised surgical equipment relevant to the area of their work
  • Handling of tissues and manipulating of organs for exposure or access under direct observation of the operating surgeon
  • Superficial and deep tissue retraction
  • Assistance with haemostasis to secure and maintain a clear operating field, including indirect application of surgical diathermy as directed by the operating surgeon
  • Use of suctions guided by the operating surgeon
  • Camera and instrument manipulation under the direction of the surgeon during minimal access surgery
  • Cutting of deep sutures and ligatures
  • Assistance with wound closure – cutting of sutures and ligatures
  • Application of dressings
  • Assistance with the transfer of patients to the postoperative anaesthetic care unit

Supervision and management

  • The SFA is responsible to the theatre management team and is clinically responsible to the consultant surgeon, who delegates aspects of surgical assistance to the SFA
  • As a registered practitioner the SFA also has a professional and legal responsibility to the patient through professional codes of conduct and a duty of care
  • Day to day work under the direction of the operating surgeon and the theatre management team


The surgical first assistant works under the direct supervision of a surgeon who must remain in theatre until surgery is completed.

Eligibility for training

  • Registration as a healthcare professional (e.g. nurse, operating department practitioner, or psychotherapist)
  • 1-2 years of post-registration experience
  • Aptitude for clinical and operative practice


  • Successful completion of a nationally recognised programme of study, such as a University accredited programme or an in-house training package supported by the AfPP competency toolkit
  • Universities that offer accredited modules for SFAs must ensure that the programme offered follows the recommendations of the Perioperative Care Collaborative

Professional accountability

  • Nursing and Midwifery Council, or Health and Care Professions Council, for their original, non-extended roles
  • It is recommended that SCPs follow the Association for Perioperative Practice (AfPP) voluntary code of conduct for registered practitioners working in advanced surgical roles


Variable, depending on organisation.

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