During a laparoscopic cholecystectomy, the surgeon identifies the Critical View of Safety before clipping and dividing structures. What does this involve?

Clearly identifying the cystic duct and cystic artery in Calot's triangle. The Critical View of Safety (CVS) requires clear identification of the cystic duct and cystic artery within Calot's triangle (bordered by the cystic duct, common hepatic duct, and liver edge). The lower third of the gallbladder must be dissected off the liver bed. Achieving CVS reduces the risk of bile duct injury, the most feared complication of cholecystectomy.

McBurney's point, the landmark for an appendectomy incision, is located:

One-third of the distance from the right ASIS to the umbilicus. McBurney's point is located one-third of the distance from the right anterior superior iliac spine (ASIS) to the umbilicus. It marks the surface landmark for the base of the appendix and is the site of the McBurney incision (oblique) or Rocky-Davis incision (transverse) for an open appendectomy.

A cesarean section requires a separate setup for the newborn. What is the PRIMARY reason for this?

To have resuscitation equipment, suction, and a warmer ready for immediate neonatal care. A separate newborn setup (radiant warmer, suction, cord clamp, blankets, resuscitation equipment) must be ready for immediate neonatal assessment and care after delivery. The newborn may need suctioning, warming, stimulation, or resuscitation depending on their condition at birth.

During a total hip arthroplasty, which intraoperative measure helps reduce the risk of prosthetic joint infection?

Using laminar airflow ventilation and body exhaust suits. Total joint arthroplasty requires strict infection prevention measures because prosthetic joint infections are devastating. Laminar airflow ventilation provides unidirectional, filtered air over the surgical site. Body exhaust suits (space suits) filter the surgical team's shed skin cells and bacteria. These measures, combined with prophylactic antibiotics, significantly reduce infection risk.

Key Takeaways

Laparoscopic cholecystectomy is one of the most commonly performed surgeries — uses 4 trocar ports
Appendectomy can be performed open (McBurney/Rocky-Davis incision) or laparoscopically
Total joint arthroplasty (hip/knee) requires strict sterile technique due to implant infection risk
Cesarean section (C-section) requires two setups: one for the mother and one for the newborn
Hernia repair (inguinial) uses mesh reinforcement in most modern approaches
Thyroidectomy requires recurrent laryngeal nerve identification and monitoring
The surgical technologist must know the key steps, instruments, and positioning for each procedure
Surgical approaches include open, laparoscopic, robotic, and endoscopic methods

Common Surgical Procedures

The CST exam tests knowledge of common surgical procedures across multiple specialties. You should know the positioning, prep, draping, instruments, key steps, and potential complications for each.

General Surgery

Laparoscopic Cholecystectomy (Gallbladder Removal)

Position: Supine, reverse Trendelenburg
Access: 4 trocar ports (umbilical for camera, epigastric, 2 subcostal)
Key Steps: Identify the Critical View of Safety (cystic duct and cystic artery clearly seen in Calot's triangle), clip and divide cystic duct and artery, dissect gallbladder from liver bed
Instruments: Trocar/cannula set, laparoscope (30°), graspers, clip applier, electrocautery hook/spatula, specimen bag
Complication to know: Bile duct injury (most feared)

Appendectomy

Open approach: McBurney (oblique) or Rocky-Davis (transverse) incision at McBurney's point (1/3 from ASIS to umbilicus)
Laparoscopic: 3 trocar ports
Key Steps: Ligate mesoappendix, ligate base of appendix, divide and remove, sometimes invert stump with purse-string suture
Specimen: Always sent to pathology

Inguinal Hernia Repair

Position: Supine
Types: Direct (medial to inferior epigastric vessels) vs. indirect (lateral to inferior epigastric vessels through internal ring)
Key Steps: Identify hernia sac, reduce contents, reinforce with mesh (Lichtenstein tension-free repair is standard)
Structures to protect: Spermatic cord (males), ilioinguinal nerve

Orthopedic Surgery

Total Hip Arthroplasty (THA)

Position: Lateral (posterior approach) or supine (anterior approach)
Key Steps: Femoral head dislocation, neck osteotomy, acetabular reaming and cup placement, femoral canal preparation and stem insertion, trial reduction, final implant placement
Instruments: Power saw, reamers, impactors, trial components, cement (if cemented)
Sterile considerations: Laminar air flow hoods, body exhaust suits, antibiotic cement may be used

Open Reduction Internal Fixation (ORIF)

Purpose: Surgical repair of fractures using plates, screws, rods, or wires
Instruments: Power drill, fracture reduction clamps, screw sets, plates
C-arm (fluoroscopy): Used intraoperatively to verify fracture reduction and hardware placement

Obstetric/Gynecologic Surgery

Cesarean Section (C-Section)

Position: Supine with left uterine displacement (prevents aortocaval compression)
Incision: Pfannenstiel (low transverse skin) or vertical midline (emergency)
Key Steps: Open layers to uterus, incise lower uterine segment, deliver baby, deliver placenta, close uterus in layers
Two setups: Sterile instrument set for the procedure AND a separate setup for the newborn (warmer, suction, cord clamp)
Time-critical: Goal is delivery within 30 minutes of decision for emergency C-section

ENT Surgery

Tonsillectomy/Adenoidectomy (T&A)

Position: Supine with neck extended, mouth gag (Crowe-Davis or McIvor) in place
Instruments: Mouth gag, tonsil snare, Hurd dissector/pillar retractor, electrocautery (suction Bovie), adenoid curette
Blade: #12 scalpel blade (hooked) commonly used
Complication: Hemorrhage (most common)

CST Certified Surgical Technologist Exam

1Introduction: CST Exam Overview

2Chapter 1: Perioperative Care — Preoperative Preparation

3Chapter 2: Perioperative Care — Intraoperative Procedures

4Chapter 3: Postoperative Procedures & Ancillary Duties

5Chapter 4: Basic Science

6Chapter 5: Exam Strategy & Practice