Intraoperative Procedures Key Terms
Master these terms for the highest-weighted domain on the CST exam, the INTRA domain. Terms are grouped by topic area.
Sterile Technique
Sterile field
The draped area immediately around the surgical site, maintained free of pathogenic microorganisms throughout the procedure.
Sterile conscience
The internalized commitment to self-report any suspected break in sterile technique immediately, regardless of whether anyone else noticed.
Strikethrough
Fluid soaking through a drape or gown, compromising sterility from one side to the other.
Neutral zone
A designated hands-free area for passing sharps between team members to reduce sharps injury risk.
Instrumentation
Metzenbaum scissors
Long, thin, delicate scissors used for cutting fine tissue and fascia.
Kelly clamp
A serrated hemostatic clamp used to occlude vessels and tissue.
Babcock forceps
Fenestrated, non-crushing forceps used to grasp delicate structures such as bowel or fallopian tube.
Self-retaining retractor
A retractor that holds tissue open without requiring a hand to maintain tension (e.g., Weitlaner, Balfour).
Ring-handled instrument
An instrument with finger-ring handles, typically a clamp or scissor, often organized on a stringer.
Counts and Accountability
Baseline count
The initial sponge, sharps, and instrument count performed before the procedure begins.
Closing count
A count performed before closure of a cavity within a cavity and again before closure of the primary wound.
Retained surgical item (RSI)
A sponge, instrument, or other item unintentionally left inside a patient - considered a preventable "never event."
Count discrepancy
An incorrect count result requiring immediate notification of the surgeon, recount, systematic search, and possible intraoperative imaging.
Hemostasis
Electrosurgery
Use of high-frequency electrical current to cut and coagulate tissue.
Monopolar
Electrosurgical mode requiring a dispersive return electrode pad, with current passing through the patient's body.
Bipolar
Electrosurgical mode where current passes only between the two tips of the forceps; no grounding pad required.
Ligature
A strand of suture tied around a vessel or tissue to occlude it.
Hemostatic agent
A chemical or biologic material (e.g., Surgicel, Gelfoam, topical thrombin) applied to assist clot formation.
Wound Closure
Primary intention
Wound closure with approximated edges at the time of surgery.
Secondary intention
Wound healing left open via granulation and epithelialization.
Suture
Material used to approximate tissue, classified as absorbable/nonabsorbable and monofilament/braided.
Needle holder
An instrument used to grasp and control a suture needle during tissue closure.
Specimen Handling
Chain of custody
The documented, unbroken sequence of specimen handling from removal to pathology receipt.
Frozen section
A rapid intraoperative pathology technique used to guide surgical decision-making in real time.
Minimally Invasive Surgery
Pneumoperitoneum
Insufflation of the abdominal cavity with CO2 gas to create a laparoscopic working space.
Trocar
A device that creates a portal through the body wall for laparoscopic instrument passage.
Veress needle
A spring-loaded blunt-tip needle used to establish pneumoperitoneum before initial trocar placement.
Robotic-assisted surgery
Minimally invasive surgery performed using a surgeon-controlled robotic platform with articulating instruments.
Emergency Situations
Malignant hyperthermia
A life-threatening hypermetabolic anesthetic reaction treated with dantrolene.
Fire triangle
The three elements (ignition source, fuel, oxidizer) required for an OR fire to occur.
Continue with the INTRA exam tips or review the full INTRA study guide.