OB/GYN and Urology Scrub Sequences

Objective. Students correctly set up and scrub for a simulated cesarean section and a simulated cystoscopy, adapting instrument and supply selection to each specialty's specific requirements.

Surgical technologists working in obstetrics/gynecology (OB/GYN) and urology face distinct setup demands in each specialty. Mastering both prepares you for a broad range of cases and strengthens your adaptability as a scrub technologist. This lesson focuses on two representative procedures: the cesarean section (C-section) and the cystoscopy.

Cesarean Section: Setup and Scrub Considerations

A cesarean section is a major abdominal surgery performed to deliver a neonate through incisions in the uterus and abdominal wall. Speed and sterile precision are critical because two patients — the mother and the newborn — depend on your readiness.

Instrument set: The standard OB instrument set includes abdominal retractors (such as a bladder blade and hand-held retractors), hemostatic clamps, tissue forceps, needle holders, scissors, and suction equipment. You will also need a bulb syringe for clearing the neonate's airway immediately after delivery. Neonatal items — typically a warm blanket, cord clamps, and a cord scissors — must be organized and ready at the field before the uterine incision. These items should be set to one side of the back table in a clearly designated neonatal zone so you can hand them off without confusion.

Draping: The patient is positioned supine with a slight left lateral tilt to relieve aorto-caval compression. The cesarean drape set includes a fenestrated abdominal drape and, in many facilities, a clear adhesive incise drape applied over the prepared skin. A screen or drape barrier may be placed at chest level so the patient, if awake under regional anesthesia, cannot see the operative field.

Sutures: Absorbable sutures in several sizes are needed for the uterine closure, fascial layer, subcutaneous tissue, and skin. Know which suture the surgeon prefers for each layer before the case begins. Count protocols — sharps, instruments, and sponges — must be completed before the uterine incision and again before closure of each anatomical layer.

Safety priority: Because the neonate is delivered onto the sterile field, the bulb syringe and cord clamps must be confirmed present and functional before the skin incision. A missing or defective bulb syringe is a patient-safety event. Communicate any missing item immediately.

Cystoscopy: Setup and Scrub Considerations

Cystoscopy is an endoscopic procedure in which a cystoscope is passed through the urethra to examine the bladder and urethra. It may be diagnostic or therapeutic (e.g., biopsy, stone retrieval, ureteral stent placement).

Patient positioning: The patient is placed in the lithotomy position — supine with hips and knees flexed and legs supported in stirrups. Both legs must be raised and lowered simultaneously to prevent hip or nerve injury. The lithotomy drape is designed with leg pouches that accommodate the stirrups while maintaining the sterile field over the perineum.

Equipment: Cystoscopy uses a cystoscope (rigid or flexible), a light source, an irrigation system (typically sterile water or normal saline at room temperature), a collection system for irrigant return, and a video tower. In the practice lab you will work with the cystoscopy cart and a flexible scope trainer model only — no powered equipment is used during simulation. You must still set up the irrigation tubing, drape the cart, and organize ancillary instruments (graspers, biopsy forceps, stent delivery systems) as if for a live case.

Scope handling: Cystoscopes are delicate and expensive. When passing the scope, support its full length. Never allow the scope to hang unsupported from the field. After the procedure, handle the scope according to your facility's decontamination protocol; in practice, simulate this step by verbally stating the steps aloud.

Irrigation safety: Bladder distension with irrigation fluid is necessary for visualization. Excessive absorption of irrigation fluid can cause fluid overload — particularly with hypotonic solutions. Know which irrigant is selected for each case and verify the bags before the case begins.

Adapting Your Setup to Each Specialty

Both procedures require you to review the surgeon's preference card before building your setup. The preference card lists instrument names, counts, suture preferences, and special requests. Cross-reference the card with your setup checklist for each case. When you identify a discrepancy — a missing item or an incorrect item — report it before the case begins. Correcting a gap before the first incision is far safer and less disruptive than discovering it mid-case.

Comparing and Documenting Deviations

After each simulated case, compare your actual setup to the reference standard. Record every deviation — even minor ones — in your reflective setup log. For each deviation, ask: Could this have harmed the patient? Could it have interrupted case flow? A missing neonatal cord clamp in a C-section or a mismatched cystoscope bridge in a urology case are not trivial omissions; document the potential consequence clearly. This habit of structured self-review is essential to professional growth and to the analytical thinking tested on the CST examination.

Key terms9

Cesarean section (C-section)A surgical procedure in which the neonate is delivered through incisions made in the mother's abdominal wall and uterus rather than through the vaginal canal.

Bulb syringeA soft, bulb-shaped suction device used immediately after delivery to clear mucus and fluid from the neonate's nose and mouth; a required item on the sterile field before uterine incision.

CystoscopyEndoscopic examination of the urethra and bladder using a cystoscope passed transurethrally; may be diagnostic or include therapeutic interventions such as biopsy or stent placement.

Lithotomy positionSurgical patient position in which the patient lies supine with both hips and knees flexed and legs elevated and supported in stirrups; used for perineal, urologic, and some gynecologic procedures.

Preference cardA surgeon-specific document listing preferred instruments, sutures, supplies, and special requests for a given procedure; the primary reference used when building a sterile setup.

Irrigation fluidSterile solution (such as normal saline or sterile water) used to distend the bladder during cystoscopy to allow visualization; the type and volume must be verified for each case because inappropriate fluid can cause patient harm.

Neonatal zoneA designated, clearly organized area on the back table during a cesarean section where all items needed for immediate newborn care — cord clamps, bulb syringe, warm blanket — are grouped and ready for rapid handoff.

Reflective setup logA written document in which the scrub student records deviations from the reference standard setup, describes the potential patient-safety or case-flow impact of each deviation, and identifies corrective actions.

Aorto-caval compressionPressure on the inferior vena cava and aorta caused by the gravid uterus when a pregnant patient lies flat supine; relieved by a left lateral tilt during cesarean section to maintain maternal blood pressure and fetal perfusion.

In class: Pre-lab preparation: students research the instrument and supply needs for a cesarean section and a cystoscopy using the program's specialty procedure reference and create a written setup checklist for each. · Lab session: students set up for each procedure in sequence, with instructor verification of the setup checklist before the simulated case begins; the instructor or lab assistant provides verbal surgeon cues. · Post-lab debrief: students compare their actual setups to the reference standard, document deviations in a reflective setup log, and state how each deviation could affect patient safety or case flow.
Materials: OB instrument set including bulb syringe and neonatal items, cystoscopy tower (cart only, no power for practice), flexible scope trainer model, lithotomy drape set, cesarean drape set, specialty procedure reference binder, setup checklist template, reflective log form
Check: Instructor verifies each setup checklist against the reference standard before the case begins; students must achieve 90% item accuracy on each checklist and demonstrate correct draping for the assigned position with no contamination events.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.