The operating room (OR) can be a tense place. There are times in the OR when only a few words will be spoken for what seems like an eternity. This is a list of words you will not find in First Aid, Dr. Pestana’s Surgery Notes or the NBME Surgery Shelf exam. Knowing what those words mean and their context will help your situational awareness and learning experience in the OR during your surgery rotation.
4×4 (“Four-by-Four”)
What the layperson might think: a vehicle with the ability to send torque power to four different wheels.
What it means in the OR: a four inch x four inch piece of gauze.
Airplane
What the layperson might think: a flying machine.
What it means in the OR: tilting the bed (and patient) in the roll axis to expose a lateral portion or change the patient’s hemodynamics.
Army Navy
What the layperson might think: the branches of the military that protect the land and sea, respectively.
What it means in the OR: a retractor with heads on both ends, one wider than the other. I surmise that the “Army side” is the bigger side since the Army has more personnel, has produced more U.S. Presidents, and even has more boats than the Navy. There is no clear consensus on the history of the name.
Bair Hugger
What the layperson might think: someone who hugs bears and spells incorrectly.
What it means in the OR: a plastic sheath/blanket that has a constant supply of warm air piped in to help the patient maintain body temperature in the normally chilly (66-68F) OR.
Bipolar
What the layperson might think: a psychiatric condition that has manic and depressive features.
What it means in the OR: a piece of equipment shaped like tweezers… I mean, forceps! The bipolar is used for cauterization. It provides more precision and decreases the chance of unwanted tissue damage than the traditional cauterization tool, the “Bovie.”
Bovie
What the layperson might think: someone butchering Jon Bon Jovi’s name? A slang term for bovine?
What it means in the OR: named after Dr. Bovie, this is an instrument that has a “cut” and “cautery” function (you will hear this term a lot in nearly any procedure). Some purists may call it “cautery” because “Bovie” is an eponym for the tool’s inventor, similar to the “Kleenex” versus “tissue” conundrum.
Christmas Tree
What the layperson might think: the place where Santa Claus places gifts on Christmas morning.
What it means in the OR: the thing anesthesiologists use to protect their tubes and cords from becoming tangled or compressed. You will likely be tempted to rest your hand or some weight on the “Christmas tree” during a long procedure, and the anesthesiologist will likely tell you to get off their equipment.
The Count (not of Monte Cristo)
What the layperson might think: a royal person who lives in a castle.
What it means in the OR: the scrub tech/nurse accounts for every surgical instrument, sharp object, sponges, etc that may possibly be left inside the patient. The count occurs before the procedure begins, anytime the scrub tech/nurse switches out, many times throughout the procedure depending on personnel preference and local policy, before closing the fascia, and at the conclusion of the procedure. If the count is not correct, there will be an extensive search for the missing item. If the missing item is not found, the patient may need an x-ray to check for retained items.
Cocaine
What the layperson might think: an alpha-1 agonist traditionally used for illicit recreational purposes.
What it means in the OR: can be used as a vasoconstrictor and local anesthetic for nasal procedures.
Donut
What the layperson might think: a delicious circular pastry.
What it means in the OR: a support for the patient’s head to help keep it in place that usually replaces the patient’s pillow after anesthetic induction.
Drain
What the layperson might think: where water goes after you take a shower or wash your hands.
What it means in the OR: a “Penrose” drain is placed in many operative sites to prevent fluid accumulation. Once a drain has less than 30mL of output in 24 hours, it can usually be removed, a great task for a learning medical student.
Gator
What the layperson might think: a hungry carnivore waiting to chomp anything that gets too close to its swampy home.
What it means in the OR: a surgical tool used to grasp in tight spaces, such as the ears or nose.
Irrigation
What the layperson might think: the technological advancement that contributed to humankind’s advancement from a nomadic hunter/gatherer species into an agrarian based species.
What it means in the OR: a turkey-baster-like piece of equipment filled with normal saline that is used to irrigate (don’t use the term in the definition… facepalm), er, clean the operative site of any blood/debris. You will hear this term a lot in nearly any procedure.
Jump Room
What the layperson might think: a trampoline park called Sky Zone.
What it means in the OR: it means that there is another OR waiting for your surgeon usually staffed with another team (anesthesiologist, scrub tech/nurse, and circulator), so that the surgical team does not have to wait for OR turnover/cleaning.
Pedals
What the layperson might think: the part that connects you feet to your bicycle (or tricycle or unicycle)?
What it means in the OR: there are pedals for many pieces of surgical equipment including the Bovie (cautery), bipolar, coblator, scope cameras, etc. Before starting the operation, help the OR staff make sure the pedals are plugged into the right machines and positioned at the correct spot for the operator.
Snow
What the layperson might think: a fluffy form of water that falls from the sky and provides great skiing.
What it means in the OR: Snow, brand name Surgicel, is a hemostatic agent. When used it is usually placed at the conclusion of procedures.
Sponge
What the layperson might think: Bob Squarepants’ first name? A fungi? What you use to wash dishes?
What it means in the OR: Anything used to absorb blood. Laparotomy sponges may also be called “laps.” They do not look like the other types of aforementioned sponges, but rather look more like rags.
Suction
What the layperson might think of: the rubber circles that stick to windows or the cups that Olympic swimmers use.
What it means in the OR: a way to remove blood and or “irrigation” from the operative site. You will hear this term a lot in nearly any procedure. “Suction” nearly always follows “irrigation.” So, look for the scrub tech/nurse to pass you the suction handle after the attending/resident asks for “irrigation.”
Valsalva
What the layperson might think: how to equalize ear pressure when ascending or descending in flight or in water.
What it means in the OR: the same maneuver but for a different reason. The Valsalva maneuver decreases preload and builds pressure in the venous system. So, it helps expose venous bleeding that might not be readily apparent.
Good luck out there. Take any advice you get seriously, but don’t take it personally. I hope this information helps make you more comfortable entering the OR!
Medical Student Editor and Contributing Writer
Indiana University School of Medicine
Michael is a third-year medical student at Indiana University School of Medicine in Indianapolis, Indiana, class of 2021. Formerly, he served as an Army Aviation Officer (UH-60 Blackhawk Pilot) in the 82nd Airborne Division at Fort Bragg, North Carolina. He is a graduate of the United States Military Academy at West Point, New York where he earned a Bachelor of Science in economics. In his free time, he enjoys spending time with his wife and son, basketball, endurance athletics, and reading. After he graduates from medical school, Michael would like to practice within the Veterans Health Administration.