Page Content

What does a surgical first assistant do?

A surgical first assistant, also referred to as a surgical assistant or simply a first assist, works closely with surgeons in the operating room during a surgical procedure. They anticipate the needs of the surgical team and during an operation, assist the surgeon with tasks such as selecting equipment, holding open incisions, stopping bleeding, closing the incision, among other technical tasks.

Scope of practice

Surgical first assistants interact with surgeons, anesthesiologists, nurses, and other health care staff. They work very closely with patients of all ages. They have responsibilities before, during, and after surgical procedures.

Common roles and responsibilities of a surgical first assistant include:

  • Positioning the patient for surgery and aiding with draping
  • Clearing the area where the surgeon will operate and holding open incisions by using tissue retractors, sponges, or operating suction or irrigation equipment
  • Selecting and passing instruments and supplies during an operation
  • Stopping bleeding by sponging, clamping, tying, or cauterizing vessels, or suturing tissue layers as directed by the surgeon
  • Applying dressings to surgical wounds
  • Counting sponges, needles, and other materials before and after the operation
  • Closing the incision at the end of the procedure

The list above is certainly not comprehensive as the role of a surgical first assistant will vary greatly depending on the surgical procedure, specialty area, and type of facility.

Surgical first assistant vs. surgical technologist

While similar, the duties of a surgical technologist and surgical first assistant vary. A surgical technologist is responsible for surgical equipment management and preparing the operating room. The surgical first assistant is more focused on assisting the surgeon during surgery. Depending on the facility, specific duties may be interchangeable between surgical first assistants and surgical technologists.


There are currently no formal specialization programs for certified surgical first assistants, but this role is needed across virtually all types of specialty surgeries. Depending on the institution or hospital, a surgical first assistant may help with a variety of specialty areas including: 

  • Cardiovascular intervention
  • Cardiothoracic
  • Clinical
  • Neurosurgery
  • Obstetrics and gynecology
  • Ophthalmology
  • Orthopedics
  • Oral and maxillofacial procedures
  • Pathology
  • Plastic and reconstructive surgery

Work environment

Surgical first assistants most often work in hospital operating rooms, outpatient centers, or specialty departments.

Surgical first assistants work daytime or evening shifts and can be on call for overnight or weekend periods on a rotating basis. This role requires you to be on your feet for long periods of time during a shift.

Becoming a surgical first assistant

Many employers may look for surgical first assistants who are able to perform well under pressure, work efficiently with attention to detail, and are open to continuously learning about new surgical procedures and techniques.

Surgical first assistant positions are not entry-level roles; you will typically need to have several years of experience working either as a surgical technologist or another position related to surgery. While gaining operating room experience, it is helpful to develop solid professional relationships with surgeons or other surgical staff since many surgical first assistant training programs require letters of recommendation.

Higher education requirements

Admissions requirements for specific first assist training programs will vary. After a high school education or equivalent, some common education requirements and prerequisites include:

  • Bachelor's degree or two-year associate degree in surgical technology
  • Specific coursework in human anatomy, basic sciences, or microbiology
  • Several years of experience in the operating room as a surgical technologist, nurse, or other allied health position
  • Completion of an accredited surgical first assistant program

In addition to completing an accredited surgical first assistant program, most employers also require certification through the National Board of Surgical Technology and Surgical Assisting (NBSTSA) and/or the National Commission for the Certification of Surgical Assistants (NCCSA). Once certified, surgical first assistants work under the credentials of certified surgical first assistants (CSFA).

Career opportunities and outlook

Certified surgical first assistants nationwide earn a median salary of approximately $52,000. This is widely dependent on experience, qualifications, and location.  

The Bureau of Labor Statistics expects the employment of health technologists, including surgical first assistants, to grow over 7% until 2029. Advances in medical technology as well as a growing patient population in need of surgical intervention will increase demand for certified surgical first assistants nationwide.

From surgical technologist to surgical first assistant: Many surgical first assistants start as surgical technologist or surgical techs before advancing into the role of a surgical first assistant. In order to become a surgical first assistant, a surgical technologist would need to have several years of experience in the operating room, meet the prerequisites and educational requirements to apply to and complete an accredited surgical first assistant program, and then pass the exam to become a certified surgical first assistant (CSFA).

From surgical first assistant to physician assistant or registered nurse: The pathway from a surgical first assistant to physician assistant or registered nurse is not a direct path. To become a physician assistant or registered nurse, a surgical first assistant would first need to ensure they meet the educational requirements and prerequisites needed to attend a physician assistant program or nursing program. After completing an advanced degree and training program, they would need to obtain any necessary certifications needed to practice as a physician assistant or registered nurse.

From surgical first assistant to surgeon: In order to become a surgeon, surgical first assistant would need several years of advanced education and additional training. However, their surgical experience will certainly help in their journey. A surgical first assistant would first need to ensure they meet the educational requirements and prerequisites needed to attend medical school. After attending medical school, surgeons must complete several years within a residency and possible fellowship before being able to practice as a surgeon.

By the numbers

Surgical first assistant programs at Mayo Clinic

Mayo Clinic offers a one-year Surgical First Assistant Program in Rochester, Minnesota, to prepare students for a career as a certified surgical first assistant (CSFA).

Browse similar careers

Mayo Clinic nurse anesthetists monitoring a patient

Nurse anesthetist

Mayo Clinic perioperative nurses in a hospital room

Perioperative nurse

Mayo Clinic surgical technologists preparing for a procedure

Surgical technologist