The role of the Surgical Technologist (ST) is central to the functionality of the operating room (OR) team. The ST works directly alongside the surgeon, nurses, and anesthesiologists to ensure that surgical procedures are performed safely and efficiently. This article will clarify the distinct responsibilities of the Surgical Technologist and address the specific question of who performs the task of suturing and wound closure.
Core Responsibilities of the Surgical Technologist
The primary function of a certified Surgical Technologist (CST) is to maintain the sterile field and anticipate the needs of the surgeon during the procedure. This role involves the meticulous preparation of the room, including the arrangement and sterilization of all necessary instruments and equipment. They also assist in preparing the patient, such as washing and disinfecting the surgical site, and helping the surgical team to don their sterile gowns and gloves.
During the operation, the ST works directly at the operating table, often referred to as the “scrub role.” Their main intraoperative task is to pass the correct instruments, supplies, and sterile solutions to the surgeon and first assistant in a timely manner. This anticipation of needs helps the surgery flow smoothly and prevents unnecessary delays.
As the procedure concludes, the ST is responsible for performing surgical counts of all sponges, needles, and instruments used to prevent foreign objects from being retained. They also handle and prepare specimens collected during the surgery for laboratory analysis. The standard scope of practice for the Surgical Technologist focuses on maintaining the operative field and managing supplies, not on manipulating tissue for the final wound approximation.
Professional Roles Responsible for Wound Closure
The task of suturing and closing a surgical wound is reserved for licensed medical professionals or those with advanced training, as it requires complex anatomical knowledge and clinical judgment. The attending surgeon is ultimately responsible for the entire operation, including the final closure of all tissue layers. In academic or teaching hospitals, surgical residents and fellows, who are licensed physicians in training, frequently perform the closure under the direct supervision of the attending surgeon.
Wound closure involves specific medical decisions, such as selecting the appropriate suture material—which may be absorbable for deeper layers or non-absorbable for the skin—and choosing the correct technique, such as continuous or interrupted stitches. These decisions are based on the wound’s location, depth, the type of tissue, and the overall goal for optimal healing. Institutional policies and state regulations dictate which members of the surgical team are authorized to perform these invasive technical tasks.
Physician Assistants (PAs) and Nurse Practitioners (NPs) who are specifically trained and working as first assistants also commonly perform wound closure under the surgeon’s direction. The closure process often involves approximating multiple layers of tissue, including fascia, subcutaneous tissue, and the skin, which must be done precisely to prevent complications like infection. The standard Surgical Technologist does not possess the training or licensure required to perform this complex tissue approximation.
The Advanced Role of the Surgical First Assistant
While the standard Surgical Technologist does not suture, the advanced and distinct role known as the Surgical First Assistant (SFA) is authorized to perform wound closure. This is a separate credential requiring additional education, rigorous clinical experience, and certification, such as the Certified Surgical First Assistant (CSFA) credential. The SFA is an advanced allied health practitioner who works under the direct supervision of the operating surgeon.
The scope of practice for the SFA is significantly broader than that of the standard ST and explicitly includes technical functions like providing exposure, achieving hemostasis, and wound closure. SFAs are trained and expected to be proficient in various suturing techniques, knowing how to select the correct needle and suture type for different tissues. Their role involves the active manipulation of tissue throughout the procedure, including clamping, cutting, and ligating vessels.
The SFA is authorized to close all layers of the wound, including the fascia, subcutaneous tissue, and skin, as directed by the surgeon. Therefore, when a person with a background in surgical technology is observed suturing, they are functioning in the capacity of a Surgical First Assistant, having completed the necessary professional progression to assume this advanced role.