Electronic Operative Notes are generated after surgical procedures for documentation and billing. These operative notes, like many other Electronic Medical Records (EMRs) have the potential of an important secondary use: they can enable surgical clinical research aimed at improving evidence-based medical practice. Recognizing surgical techniques by capturing the structure of a surgical procedure requires the semantic processing and discourse understanding of operative notes. Identifying only predicates pertaining to surgical actions does not explain the various possible surgical scripts. Similarly, recognizing all actions and observations pertaining to a surgical step cannot be performed without taking into account discourse structure. In this paper we show how combining both forms of clinical language processing leads to learning the structure of surgical procedures. Experimental results on two large sets of operative notes show promising results.