PRODUCTS & SERVICES Anatomy of a surgical suite

Make no bones about the technology needed to run the OR by Rick Dana Barlow


f beds and patient transport equipment epitomize the workhorses of a hospital or healthcare facility, then surgical tables, lights and booms represent the skeleton of the surgical suite.

(For a report on beds and patient transport equipment, see the February 2018 edition of Healthcare Purchasing News.) Just as clinicians, administrators and supply chain professionals have witnessed numerous ergonomic improvements and technological developments in beds and patient transport equipment during the last 40 years, they surely have noticed similar developments and improvements in the workhorses of the OR. Much of what happens in the traditional or integrated surgical suite revolves around the center of the room where the surgical table is positioned with the patient atop. Lights and booms that hold electronic equipment, such as audio and video consoles, and power outlets (as well as the lights themselves) also may oc- cupy both types of surgical suites. Diagnostic and directional imaging and robotics added to the suite converts the traditional to the integrated model.

“We’ve heard consistent feedback from OpenMarkets Exchange users that when it comes to OR innovation ‘it all comes back to navigation and robots.’ I couldn’t agree with this more,” said Tom Derrick, Senior Vice President and Co-Founder, OpenMarkets. “For OR tables, this means tables are much more niche and configured to the mini- mally invasive surgical ma- chines assisting surgeons today. For example, the STERIS Surgigraphic 6000 is a purpose-built table for

Tom Derrick

guided surgery. They key innovation here is a ‘fluid top’ that allows smoother positioning of the patient. This lets the surgeons better align the patient and the surgical robots. This is a huge innovation for patient safety. “Forty years ago it was common to see clinicians picking up the sheet to reposition patients in surgery!” Derrick added. One of the foremost design progressions for surgical tables enables imaging in the OR. “Surgical C-Arm tables using isocentric

lateral roll motion are relatively new to the industry,” said Richard Schubert, MPA, BS, RT(QM), Senior Product Sales Manager,

Biodex Medical Systems Inc. “We engineered our latest Surgical C-Arm Table 840 with this unique movement enhance- ment because it does won- ders for minimizing image distortion during cardiac procedures by maintain- ing image center while the table moves. The creation of carbon fiber tabletops were another very significant

Richard Schubert

innovation from the last 15 years or so that we included in our Surgical C-Arm Tables. Instead of requiring metal support on the sides of the table, they allowed for a complete radiolucent area. Both of these innovations have made positioning more convenient and helped improve image quality.” It’s all about functional flexibility and

mobility over fixed and stationary room functionality.

“Image Diagnostics’ primary focus in- volves X-ray imaging systems that require table designs to present artifact-free imaging over as large an area as possible,” said Remo Rossi, President, Image Diagnostics. “In the early ’90s Image Diagnostics pioneered fully cantilevered table top designs to allow imag- ing systems to access patients for head to toe imaging.

“The main thrust of our product develop- ment since then has focused on improving mobile table designs to the point where they provided virtually all the same functions as one would find in a floor-mounted product,” Rossi noted. “Creating a stable yet fully mobile platform for imaging procedures has allowed hospitals, imaging centers, etc., to narrow the investment required to just capital equipment in lieu of room constructions and infrastruc- ture improvements. With the dramatic im- provements in mobile X-ray technology, many procedures that were once only completed in fixed rooms can now be accomplished using a mobile imaging suite.”

Two decades ago in 1997 the intraoperative

magnetic resonance imaging (iMRI) project was established in Winnipeg, Canada, recalled Andy Flanagan, CEO, IMRIS. The goal was to introduce a high field magnet into the OR to give neurosurgeons access to brain image de- tail during surgery that would result in greater precision and accuracy, reducing the need for additional operations as well as eliminating


exposing patients to possible infection when moving in and out of the OR, according to Flanagan.

“The founders of IMRIS understood that to minimize the need for additional sur- geries and improve patient outcomes, surgeons would need access to high-qual- ity image detail while the patient was on the table,”

Andrew Flanagan

Flanagan said. “They also understood that keeping the patient stationary while moving the MRI would be safer than moving the patient to the magnet. The result of this innova- tive thinking and development was the world’s first ceiling-mounted, moving intraoperative magnet, which has since evolved into what is now the IMRIS Surgical Theatre — a compre- hensive suite of advanced imaging technology, OR configurations and equipment.” Today’s surgical tables include an increas-

ing array of Trendelenberg positions, flexible table-top switching, the ability to support bariatric patients as heavy as 700 pounds, in- corporate mobile drives and plug-ins for vital signs monitoring. Like beds, surgical tables seem to be en route to being an extension of both the patient and the clinician. Ask industry experts about surgical light progression and they undoubtedly will home in on one aspect: Bulb type.

“Without a doubt the biggest innovation in surgical lights has been the conversion from halogen to LED,” insisted OpenMarkets’ Der- rick. “We’re now using run-cool lights that are 40 to 60 times more efficient than bulbs used just a decade or so ago.”

Image Diagnostics’ Rossi agrees. “For decades, halogen has been the source of choice for surgical lighting, despite sev- eral drawbacks,” he indicated. “Light emitted from halogen bulbs have a yellow/green appearance and do not emit in the spectrum of natural daylight required for an ideal working environment. Halogen lights have a high-power consumption and cause an increase of temperature in the operating field. Halogen lights also have a short lifetime and inferior performance in red color rendering index (R9).”

Since the introduction of LED technology in 2006, according to Rossi, surgical lighting has overcome most of the drawbacks from

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