1979
Standards established (NSAA lineage)
OR Ready Surgical Academy
Training the surgeon's second pair of hands.
ORSA prepares allied health professionals to first-assist at the operating table — credential-ready, specialty-fluent, and built for the era of robotic and minimally invasive surgery.
Status
OR READY
Calibrated for the operating field
The Academy
A surgical-first standard, not an entry-level one.
The American College of Surgeons holds that the ideal first assistant is a qualified surgeon. ORSA takes that ideal as the benchmark — training assistants to perform at the level the operating room actually demands.
Every graduate is prepared to maintain exposure and hemostasis, manage tissue and closure, and function fluently inside laparoscopic, robotic, arthroscopic, and video-assisted procedures across multiple specialties.
Built around modern operating rooms
Where ORSA-trained assistants work
Robotic surgery
Bedside assist, docking, instrument exchange, and console-side coordination.
Minimally invasive
Laparoscopic camera navigation, port placement, retraction, and energy devices.
All specialties
Plastic & reconstructive, surgical oncology, ortho, vascular, gyn, uro and beyond.
CAAHEP
Accreditation framework
2
National credentials: CSFA / CSA
950+
Target clinical hours
Figures reflect industry pathways & benchmarks — set ORSA's own metrics on launch.
Founder
Payam Katebi Kashi, CSA, F-RMIS
Certified Surgical First Assistant · Surgical Educator & Researcher
Mr. Kashi is a distinguished medical professional and Certified Surgical First Assistant based in Falls Church, VA. He is a research scientist who has led and contributed to numerous research projects, with a strong passion for women's health.
His surgical experience is extensive — supporting complex gynecologic oncology cases across robotic, laparoscopic, open, and vaginal techniques, and assisting in operations spanning urogynecology, obstetrics & gynecology, urology, and many other specialties.
Beyond the operating room, he contributes to surgical education as a Clinical Instructor at a university medical school and as Clinical Site Director for a Master of Surgical First Assistant Program, focusing on training and mentorship. He remains active in international conferences advancing surgical technique and patient outcomes worldwide — and founded ORSA to bring that same standard to the next generation of surgical first assistants.
3,600+Gyn-onc cases supported
2,800+Operations across specialties
- CSA — Certified Surgical First Assistant, NSAA
- F-RMIS — Fellow of Robotic & Minimally Invasive Surgery, NSAA
- MD, with honors — Washington University of Health and Science
- PhD, Population Health — University of Oxford
- Clinical Instructor & Clinical Site Director, Master of Surgical First Assistant Program
Surgeons don't operate alone. Neither should you train alone.
Start your application →
02 / The Role
What is a surgical first assistant?
An advanced allied health professional who works directly alongside the operating surgeon — providing the hands-on technical support that keeps a procedure safe, efficient, and on track from incision to closure.
A second pair of trained hands
Mayo Clinic describes the role plainly: the first assistant acts as a second pair of hands for the surgeon during an operation. They work in the operating room alongside surgeons, anesthesiologists, nurses, and surgical technologists — and the role sits a clear step above the surgical technologist in skill and responsibility.
The U.S. Bureau of Labor Statistics classifies surgical assistants (SOC 29-9093) as professionals who assist in operations under a surgeon's supervision — distinct from registered nurses and from surgical technologists.
Allied healthSurgeon-supervisedAbove surgical techCredentialed
Your photo — surgeon & assistant at the table
Across the case
The first assistant works in three phases
PHASE 01 — PRE-OPERATIVE
Prepare the field
Patient positioning and prepping, draping for optimal visualization, equipment readiness, and active participation in the surgical time-out.
PHASE 02 — INTRA-OPERATIVE
Assist the operation
Provide exposure, maintain hemostasis, handle and retract tissue, suction, clamp and ligate vessels, and assist with closure — performing only what they are trained and credentialed to do.
PHASE 03 — POST-OPERATIVE
Close & hand off
Wound closure and dressing, dressing application, and support of safe transfer and continuity of care.
Core intra-operative functions
What the hands actually do
- Exposure. Retraction and field management so the surgeon can see and reach the operative site.
- Hemostasis. Controlling bleeding through clamping, ligating, and cauterizing vessels and tissue.
- Tissue handling. Manipulating or removing tissue as directed during the procedure.
- Closure. Suturing and assisting in closing the surgical site, cutting suture, applying dressings.
- Devices & drains. Assisting with implants, catheters, and drains within scope and state law.
- Delegated steps. Performing specific designated portions of a procedure under active surgeon supervision.
Functions performed only under the direction and supervision of the surgeon, within hospital policy and applicable law.
03 / Scope of Practice
Defined by the field's authorities
The surgical first assistant role is shaped by national standards. ORSA trains to the consensus of the organizations that define it — so graduates arrive credential-aligned and credentialing-ready.
National Surgical Assistant Association
NSAA
- The first U.S. body to establish standards of professionalism for surgical assistants, with roots in 1979 and national status from 1983.
- Supports the ACS principle that the ideal first assistant is a qualified surgeon or surgical resident.
- Recognizes the non-physician Certified Surgical Assistant (CSA) credential via the NCCSA, following an accredited program.
Source: nsaa.net — Scope of Practice for Non-Physician CSA
Mayo Clinic
Mayo Clinic
- Defines the SFA as a second pair of hands for the surgeon: retracting incisions, controlling bleeding, and closing — among other hands-on tasks during surgery.
- Trains assistants to sit for both the CSA (NCCSA) and CSFA (NBSTSA) certification exams.
- Programs are CAAHEP-accredited and emphasize extensive supervised clinical hours across general and specialty cases.
Source: college.mayo.edu — Surgical First Assistant Program
American College of Surgeons
ACS
- States that, ideally, the first assistant should be a qualified surgeon or a resident in an approved training program.
- When unavailable, qualified non-physician assistants with additional surgical training may serve — meeting national standards and credentialed by the local authority.
- Such assistants are not authorized to operate independently; privileges are reviewed by the medical staff and bounded by state law.
Source: facs.org — Statements on Principles
The shared standard
Three sources, one consensus
Across NSAA, Mayo Clinic, and the ACS, the surgical first assistant provides aid in exposure, hemostasis, closure, and other intra-operative technical functions that help the surgeon carry out a safe operation — together with pre-operative and post-operative duties that support patient care.
These functions are always performed under the direction and supervision of the surgeon, in accordance with hospital policy and applicable laws and regulations.
- Credentialed. CSFA (NBSTSA) or CSA (NCCSA) earned through a CAAHEP-accredited pathway.
- Supervised. Operates under a named, responsible supervising surgeon — never independently.
- Privileged locally. Practice privileges reviewed and approved by the institution's medical staff.
- Bounded by law. Scope defined within state statutes and facility bylaws.
Occupational definition
What surgical assistants are permitted to do
Per the U.S. Bureau of Labor Statistics (SOC 29-9093), and in accordance with state law, surgical assistants may:
- Help surgeons make incisions and close surgical sites
- Manipulate or remove tissues
- Implant surgical devices or drains
- Suction the surgical site and place catheters
- Clamp or cauterize vessels or tissue
- Apply dressings to the surgical site
Classification excludes registered nurses (29-1141) and surgical technologists (29-2055).
04 / Why It Matters
A competent assistant changes the operation.
Surgical outcomes are a team product. The quality of the first assistant directly shapes exposure, bleeding control, operative time, and the surgeon's ability to work safely — especially as procedures grow more technically demanding.
Why surgical training is non-negotiable
The ACS sets the bar at surgeon-level for a reason: the first assistant participates in and actively assists the surgeon in completing the operation safely and expeditiously. An assistant who anticipates the next move, holds exposure precisely, and manages tissue with care is not a convenience — they are part of the margin of safety.
Under-trained assistance shows up as poor visualization, lost time, avoidable bleeding, and tissue handling errors. Trained assistance shows up as a smoother, faster, safer case.
Your photo — operating room team
What competence delivers
The case for a trained first assistant
01
Patient safety
Better exposure and hemostasis reduce intra-operative risk and complications.
02
Efficiency
Anticipation and fluency shorten operative time and turnover.
03
Surgeon focus
A reliable assistant lets the surgeon concentrate on the critical maneuvers.
04
Team standard
Consistent, credentialed assistance raises the floor for the whole OR.
Your photo — minimally invasive / robotic case
The modern OR raises the bar
Minimally invasive surgery demands more, not less
In open surgery the assistant retracts and holds. In laparoscopic, robotic, arthroscopic, and video-assisted procedures, the assistant drives the camera, manages ports, exchanges instruments, assists docking, and manipulates tissue through narrow corridors — all while reading a screen rather than the field directly.
That shift makes formal, specialty-specific training essential. ORSA is built for it.
See the training focus →
05 / Training Focus
Built for minimally invasive & robotic surgery.
ORSA's curriculum centers on the techniques that define modern operating rooms — then extends across the full range of surgical specialties an assistant will meet in practice.
Technique tracks
Approach-based training
Robotic surgery
Bedside (patient-side) assisting, robotic docking and undocking, instrument and port exchange, troubleshooting, and coordination with the console surgeon.
Laparoscopic & MIS
Camera navigation and stable visualization, trocar/port placement assistance, atraumatic retraction, energy-device handling, and intracorporeal technique support.
Arthroscopic surgery
Joint visualization and scope handling, fluid and irrigation management, portal assistance, and positioning for orthopaedic procedures.
Video-assisted surgery
Thoracoscopic and endoscopic assisting, monitor-based orientation, instrument coordination, and exposure within the working channel.
Specialty exposure
Trained for every service line
From high-complexity oncology resections to fine reconstructive work, ORSA assistants are prepared across the specialties.
Surgical oncology
Complex tumor resections, lymphadenectomy, and the sustained exposure that long, high-stakes cases require.
Plastic & reconstructive
Microsurgical assisting, flap and graft procedures, and the precise tissue handling reconstruction demands.
Gynecology & urology
Robotic and laparoscopic pelvic surgery — a core, high-volume domain for modern first assistants.
Orthopaedic
Arthroscopic and open joint, fracture, and reconstructive procedures.
General & vascular
Abdominal, hernia, and vascular access and reconstruction across open and minimally invasive approaches.
Cardiothoracic & more
Thoracic, ENT, neurosurgical and additional service lines — the full breadth of the operating schedule.
How ORSA trains
Classroom, lab, then the operating room
- Applied anatomy & technique. Foundations in surgical anatomy, asepsis, and procedure-specific skill.
- Simulation & skills lab. Suturing, knot-tying, camera handling, and instrument fluency before the live OR.
- Supervised clinical rotations. Extensive case hours across general and specialty services.
- Certification readiness. Preparation for the CSFA (NBSTSA) and CSA (NCCSA) examinations.
Your photo — skills lab / simulation
06 / Apply
Get OR ready.
Tell us about your background and goals. Whether you're entering the field or bridging from a surgical technologist role, ORSA has a pathway built for you.
Direct-entry pathway
A full classroom, lab, and clinical sequence for those entering the surgical first assistant profession — culminating in certification readiness.
CST bridge pathway
An accelerated route for experienced Certified Surgical Technologists ready to step up into the first assistant role.
Credentials you'll prepare for
CSFA — NBSTSACSA — NCCSACAAHEP-aligned
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