Bariatric Surgery
Bariatric surgery focuses on minimally invasive and robotic procedures used to treat obesity and metabolic disease. CSTs in this specialty support operations that rely on precise stapling workflows, careful tissue handling, and strict leak‑prevention protocols. These cases require long laparoscopic instruments, reliable visualization, and consistent coordination with anesthesia and the surgical team.
Role of CSTs
- Assist with trocar placement, camera management, and liver retraction systems.
- Load and verify stapler cartridges, buttress materials, and reinforcement strips.
- Support leak‑test workflows using air, methylene blue, or endoscopic insufflation.
- Manage energy devices and ensure proper insulation and safety checks.
- Handle gastric specimens and coordinate with pathology when required.
Essential Skills
- Safe handling of long laparoscopic instruments
- Camera navigation and smoke evacuation management
- Knowledge of bariatric anatomy and tissue planes
- Leak‑test preparation and troubleshooting
- Coordination during robotic docking and arm movement
- Maintaining sterile technique with large instrument exchanges
Common Procedures
- Roux‑en‑Y gastric bypass
- Duodenal switch
- Single‑anastomosis gastric bypass (OAGB)
- Revisional bariatric surgery
- Gastric band removal
Instruments & Equipment
Instruments
- Bariatric‑length trocars
- Endoscopic staplers and reloads
- Nathanson liver retractor or equivalent system
- Energy devices such as LigaSure or Harmonic
- Leak‑test supplies including methylene blue, syringes, and saline
Equipment
- Bariatric‑rated OR table and positioning devices
- Robotic system (if applicable)
- High‑definition laparoscopic tower
- Suction and irrigation setup
- Warming devices for patient temperature management
Workflow & Case Progress
- Prepare the liver retraction system and confirm proper positioning for exposure.
- Assist with trocar placement and establish pneumoperitoneum.
- Maintain visualization through camera care and smoke evacuation.
- Support stapling sequences by loading cartridges and preparing reinforcement materials.
- Prepare and assist with leak testing using air, dye, or endoscopic insufflation.
- Manage specimen retrieval and coordinate labeling for pathology.
- Maintain sterile technique during long instrument exchanges and robotic arm movements.
- Assist with closure, trocar removal, and final instrument counts
Sterile Technique Considerations
- Multiple stapler reloads must be organized and verified for correct tissue type.
- Buttress materials must remain dry and sterile until use.
- Leak‑test supplies should be staged in a dedicated sterile area.
- Robotic cases require clear arm paths and safe docking procedures.
Career Pathways
- Advanced stapling system training and vendor certification
- Cross‑training in General Surgery and Colorectal Surgery
- Participation in metabolic surgery education programs
- Advancement into bariatric program coordination roles
How to Prepare
- Practice long‑instrument handling and camera navigation.
- Review robotic docking workflows if applicable.
- Learn reinforcement materials and stapler color coding.
- Build familiarity with bariatric patient positioning and safety considerations.