When patients think about surgery, they understandably think first about their surgeon. But a successful operation depends on an entire team of highly trained professionals working together behind the scenes.
In Episode 42 of The Joint Replacement Podcast, I sat down with Alyssa Ellis, CST, CSFA, creator of Beyond Assisting, to discuss one of the most important and perhaps least understood members of that team: the surgical technologist.
Alyssa has spent more than 17 years working in the operating room as a surgical technologist and surgical first assistant. She is also an educator and author who has built Beyond Assisting to help surgical professionals better understand procedures, instrumentation, and life inside the OR.
Our conversation offered patients a rare opportunity to see what actually happens on the other side of the operating room doors.
What Does a Surgical Technologist Do?
A surgical technologist, often called a surgical tech or scrub tech, plays a central role in preparing and maintaining the sterile environment needed for surgery.
Before the patient even enters the room, the surgical tech is already working.
Sterile instruments must be opened and organized. The back table must be prepared. Equipment needs to be available. Instruments and other items may need to be counted. Every part of the setup has to be performed while maintaining sterility.
For an instrument-intensive operation such as a total knee replacement, this can be a substantial undertaking. Depending on the complexity of the procedure and experience of the team, Alyssa explained that preparation might take anywhere from roughly 15 to 45 minutes.
But setting up the room is only the beginning.
The Best Surgical Techs Anticipate What Happens Next
From a patient’s perspective, it might look like the surgical tech simply hands instruments to the surgeon.
That description dramatically understates the job.
An experienced surgical tech understands the sequence of the operation and is constantly anticipating what is going to happen next. Alyssa described it almost like a game: watching the operation progress, recognizing the current step, and having the next instrument ready before the surgeon even asks for it.
One of my favorite quotes from the episode was:
“I want to give it to them before you ask me for it, because I know what’s going on in the procedure.”
That anticipation can save time, decrease frustration, and allow the surgeon to remain focused on the patient.
It is also why experienced surgical teams can sometimes appear remarkably quiet. Everyone knows the operation, understands each other’s preferences, and anticipates what comes next.
Who Is Actually in the Operating Room?
Patients are often wheeled into an operating room and suddenly find themselves surrounded by six or eight people wearing masks, scrub caps, and gowns.
Who are all these people?
A typical surgical team may include the surgeon, anesthesiologist or certified registered nurse anesthetist, circulating nurse, surgical technologist, surgical first assistant, and sometimes an implant or equipment representative depending on the procedure.
The circulating nurse generally accompanies the patient into the room. Anesthesia is positioned at the head of the bed. The surgical tech may already be working at the sterile back table preparing instruments. A surgical first assistant may also be present and can assist the surgeon with exposure, suction, hemostasis, and other aspects of the operation.
Each person has a different responsibility, but everyone is working toward the same goal: performing the operation safely and efficiently.
Surgical Tech vs Surgical First Assistant
Alyssa holds credentials as both a Certified Surgical Technologist and Certified Surgical First Assistant, and she explained an important distinction between these roles.
The surgical tech manages the sterile field and instruments while staying ahead of the procedure and supplying the surgeon and assistant with what they need.
The first assistant works more directly with the surgeon at the operative field, potentially helping with exposure, suction, visualization, and hemostasis.
Alyssa emphasized that these are distinct responsibilities and that when she is functioning as a first assistant, she should not simultaneously be expected to perform the surgical tech’s entire role.
Surgical Techs Are Also Guardians of Sterility
One of the most important responsibilities of the operating room team is preventing infection.
Surgical techs are constantly watching the sterile field.
If a sterile package has a hole, becomes wet, contains unexpected material, or is otherwise compromised, it may no longer be considered sterile. That can mean replacing an instrument or, in some circumstances, completely rebuilding part of the surgical setup.
This can occasionally delay an operation.
From the patient’s perspective, a delay on the day of surgery can understandably be frustrating. But there may be a very good reason.
Alyssa explained that if an essential tray needs to be reprocessed and resterilized, the delay can potentially be an hour and a half or two hours depending on the facility.
The alternative would be compromising sterility, and no responsible surgical team should accept that risk simply to stay on schedule.
What Happens When Something Goes Wrong During Surgery?
Surgery does not always proceed exactly according to plan.
An instrument can fall on the floor. A glove can develop a hole. A sterile drape can become compromised. An unexpected surgical problem can occur.
This is when experience and communication become especially important.
Alyssa described surgical team members constantly watching for potential breaks in sterility. If she notices a hole in a surgeon’s glove, for example, she may already have a replacement glove ready before the surgeon realizes there is a problem.
The same principle applies when the surgical situation itself becomes stressful.
Experienced OR professionals learn to remain calm, communicate clearly, and focus on solving the problem. Alyssa noted that yelling or berating team members can have the opposite effect, particularly with inexperienced staff, because stress can cause people to freeze rather than perform better.
What Makes a Great Surgical Team?
This became one of the central themes of our conversation.
The best operating rooms are not simply collections of individually talented people.
They are teams.
Alyssa emphasized communication, appreciation, humility, and mutual respect. She also discussed how important it is for surgeons to recognize that a new team member may not yet know their individual preferences.
Likewise, surgical techs need to be willing to ask questions, learn, accept feedback, and understand exactly what the surgeon needs.
Over time, those interactions build trust.
Eventually, a team can reach the point where very little needs to be said because everyone understands the procedure and one another.
The Staffing Problem Inside America’s Operating Rooms
We also spent a significant portion of the episode discussing a challenge affecting operating rooms around the country: staff turnover and reliance on traveling surgical professionals.
Traveling surgical techs and nurses can play an essential role in keeping operating rooms functioning when permanent positions cannot be filled.
But there is a tradeoff.
A traveler may arrive, learn a surgeon’s preferences and become integrated into the team, only to leave for another assignment shortly afterward. Then the process starts again.
Alyssa argued that the bigger question hospitals should be asking is why permanent staff are leaving in the first place.
Compensation matters, but she believes the answer goes beyond compensation.
Training matters.
Culture matters.
Feeling appreciated matters.
Having experienced people available to teach new employees matters.
Her point was particularly interesting: hospitals may sometimes view staffing as numbers on a spreadsheet, where losing one employee and hiring another appears to restore the same staffing level.
Inside the operating room, however, those two people are not necessarily interchangeable.
A team member who has worked with the same surgeons for years carries institutional knowledge, understands individual preferences, knows the equipment, recognizes potential problems, and contributes to the rhythm of the room.
Losing that experience can affect the entire team.
Are Total Joint Replacements Fun for Surgical Techs?
Of course, this is The Joint Replacement Podcast, so I had to ask Alyssa about orthopedics.
Her answer was an enthusiastic yes.
She enjoys total joint replacement because of the instrumentation, drills, saws, pace of the operation, and the rhythm that develops when an experienced team works together.
She also enjoys orthopedic trauma and the challenge of helping put bones back together.
When I asked whether she preferred predictable primary joint replacements or more complicated revision surgery, she chose a mixture of both. Revisions provide an opportunity to solve problems, work with less frequently used systems, and challenge yourself to remember how different components and instruments work.
And if she could scrub only one operation for the rest of her career?
Total knee replacements.
She likes that different knee systems have enough variation to keep things interesting.
And Who Controls the Music in the OR?
We finished with some rapid-fire questions about life inside the operating room.
When I asked who gets to choose the music, Alyssa’s answer was perfect:
“Should be the tech, but surgeon.”
Her preference?
1990s and 2000s music, including Britney Spears and NSYNC.
And the surgical specialty that has the most fun?
Alyssa may be biased, but she picked orthopedics.
The Bigger Takeaway
Patients choose their surgeon, and the surgeon carries enormous responsibility for the operation.
But surgery is never truly a one-person endeavor.
Behind every successful operation is a team of professionals preparing equipment, maintaining sterility, administering anesthesia, anticipating problems, passing instruments, assisting the surgeon, and responding when something unexpected happens.
Experienced surgical technologists are an essential part of that system.
And one of the biggest lessons from my conversation with Alyssa Ellis is that building excellent surgical teams requires more than simply filling every position on a staffing schedule.
It requires experience, training, communication, trust, and a culture in which every member of the team understands that their contribution matters.
Watch or Listen to Episode 42
Episode 42: Inside the Operating Room: The Surgical Tech’s Critical Role with Alyssa Ellis, CST, CSFA
Watch the full conversation on The Joint Replacement Podcast on YouTube, or listen on Spotify and your favorite podcast platform.
Alyssa can also be found through Beyond Assisting, where she creates educational content and resources for surgical professionals. She discussed her books, educational app, online content, and other surgical education projects at the end of our conversation.
Have you ever wondered about something that happens behind the scenes in the operating room? Send us your questions for a future episode of The Joint Replacement Podcast.