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Mayo Clinic surgical first assistant managing instruments

What does a surgical first assistant do?

A surgical first assistant, also referred to as a surgical assistant or simply a first assist, works 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 many other technical tasks.

They are advanced allied health practitioners who provide aid in exposure, wound closure, bleeding control, and other intraoperative technical functions that help the surgeon carry out a safe operation with optimal results for the surgical patient. The surgical assistant performs these tasks under the direction and supervision of the surgeon and in accordance with hospital policy and appropriate laws and regulations.

Video: Behind the Scenes: Surgical First Assistant


Video: Behind the Scenes: Surgical First Assistant

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:

  • Communicating the surgeon’s preferences and specific patient needs to surgical team
  • Positioning the patient to provide the necessary exposure for the procedure, as well as the surgeon preference
  • Providing intraoperative skills such as visualization, trocar insertion, injection of local anesthetics, hemostasis, tissue handling, placement and securing of wound drains, and closure of body planes
  • Having knowledge of and using all open, laparoscopic, and robotic equipment necessary for a procedure
  • Proficiency in technical skills required during a surgical procedure, including, but not limited to: clamping, cauterizing, suturing, inserting, injecting, manipulating, retracting, cutting, and ligating tissue as necessary
  • Utilizing appropriate suturing techniques, according to surgeon preference, to close the incision at the end of the procedure
  • Providing postoperative skills in patient care such as applying dressings to surgical wounds, patient transfer and transport, transfer of care, and monitoring for immediate complications
  • Collaborating with others to provide continuity of care

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 surgical technologist and surgical first assistant are two distinct roles. A surgical technologist is responsible for surgical instrumentation, management of the sterile field, and preparation of the operating room. A surgical first assistant is more focused on assisting the surgeon during surgery. Depending on the facility, specific duties may vary between surgical assistants, surgical technologists, and the surgical nurse.


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: 

  • Cardiac
  • Cardiothoracic
  • General and colorectal surgery
  • Neurosurgery
  • Obstetrics and gynecology
  • Ophthalmology
  • Orthopedics
  • Oral and maxillofacial procedures
  • Plastic and reconstructive surgery
  • Transplant
  • Urology
  • Vascular

Work environment

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

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.

Quality surgical assisting programs are identified by earning accreditation from the Accreditation Review Council on Education in Surgical Technology and Surgical Assisting (ARC/STSA), a collaborative effort including Association of Surgical Assistants (ASA), American College of Surgeons (ACS), and Subcommittee on Accreditation for Surgical Assisting (SASA), and by Commission on Accreditation of Allied Health Education Programs (CAAHEP).

CAAHEP is a recognized accreditation agency of the Council for Higher Education Accreditation (CHEA). In addition, surgical assisting programs are associated with educational centers that are institutionally accredited by agencies recognized by the United States Department of Education (USDE), The Joint Commission, or a state agency acceptable to CAAHEP and the ARC/STSA.

To find an educational program to become a surgical assistant, visit the CAAHEP website and search to find an accredited program. Current CAAHEP-accredited programs range from 12 months to 24 months. Surgical assisting is a specialty profession that requires specific training over and above a degree in science or a health profession. Graduates of a CAAHEP accredited program are eligible to sit for national certification examinations through the National Board of Surgical Technology and Surgical Assisting (NBSTSA) or National Commission for the Certification of Surgical Assistants (NCCSA).

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:

  • Associate degree in allied health field
  • Bachelor's degree in a health-related science
  • Specific coursework in human anatomy, basic sciences, or microbiology

Applications to the various educational programs can be competitive; enhance your resume by:

  • Gaining experience in the health care setting with Certified Nursing Assistant (CNA), Phlebotomy, Surgical Core Technician, Emergency Medical Technician (EMT), or other allied health positions
  • Obtaining and maintaining CPR/BLS certification
  • Volunteering in hospitals, long-term facilities, or other health care settings
  • Joining in on team-focused activities, such as sports or collaborative organizations

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 assistants work under the credentials of Certified Surgical First Assistant (CSFA) or Certified Surgical Assistant (CSA).

Career opportunities and outlook

Certified surgical first assistants nationwide earn a median salary of approximately $48,320. 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 9% until 2030. 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) and/or Certified Surgical Assistant (CSA).

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