Anatomy of a surgical suite

If 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 occupy both types of surgical suites. Diagnostic and directional imaging and robotics added to the suite converts the traditional to the integrated model.

“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 enhancement because it does wonders for minimizing image distortion during cardiac procedures by maintaining image center while the table moves. The creation of carbon fiber tabletops were another very significant 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 involves 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 imaging systems to access patients for head to toe imaging.

“The main thrust of our product development 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 infrastructure improvements. With the dramatic improvements 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 detail 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 surgeries and improve patient outcomes, surgeons would need access to high-quality image detail while the patient was on the table,” 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 innovative 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 comprehensive suite of advanced imaging technology, OR configurations and equipment.”

Today’s surgical tables include an increasing array of Trendelenberg positions, flexible table-top switching, the ability to support bariatric patients as heavy as 700 pounds, incorporate 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’ Derrick. “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 several 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 halogen, lowering power consumption and temperature and providing better quality lighting closer to that of natural daylight.

For some, developments in surgical booms may not have been as dramatic as what transpired with lights and tables.

“Booms have seen steady, incremental innovation over the past few decades,” Derrick observed. “There’s been no single big ‘ah-ha’ innovation like the advent of LED lights. Instead, we’ve seen manufacturers making fundamental design improvements to allow for a smaller footprint, better shelves and smoother braking systems.”

However, Derrick’s closing observation certainly remains noteworthy. Booms, by and large, functioned as a convenient room organizer, designed in part to control, if not eliminate the mess of cable and cord spaghetti snaking across the floor as a potential traffic hazard in an already intense area. Many surgical suites today — particularly the integrated models — include a variety of booms suspended from articulating arms connected to ceiling mounts. During the last two decades or so, clinicians saw that model inverted with booms affixed to the floor instead of the ceiling. One of the more recent developments in booms removes the stationary characteristic by placing booms on wheels so they’re mobile.

After the snapshot of what’s happened how about a glimpse of what’s to come?

Aside from the variety of functional tools to add to a boom as surgeries become more complex, sources indicate that the ceiling and floor mounts (no wall mounts) and mobile varieties capstone boom development. Wireless capabilities, however, offer an intriguing “what if” scenario for boom development and progression.

Lights, on the other hand, may offer some possibilities.

“In the past, developments in the medical industry have been influenced by developments in other sectors, such as the automotive sector,” Rossi said. “This trend could continue and we could see developments such as gesture or voice control for surgical lights. Also, an alternative way of how surgical lights are installed within the operating room could be one of the innovative developments in the future.”

Meanwhile, Derrick points to more administrative issues.

“We aren’t aware of any fundamental innovations coming down the pike for surgical lights and booms,” he indicated. “However, as providers merge and get better at consolidating their capital data, we expect to see a more proactive approach to purchasing lights and booms. This equipment is often bought at the same time, and providers with good data can collaborate with manufacturers on both purchases easier. This makes it more efficient to not only contract but also to evaluate all the options in the market.”

Expect more development and innovation to emerge with tables, experts agree, particularly targeting clinical specialties.

ROSSI: “Image Diagnostics will be launching an advanced urology table in 2018,” Rossi revealed. “New products will refocus on capabilities that are more closely aligned with the increasing emphasis on endoscopic procedures. Our new urology table will feature a more ‘camera-centric’ design and integrated video processing and visualization. We have also recently introduced an upgraded line of advanced vascular tables with a 600-pound patient capacity as well as enhanced ranges of motions.”

Flanagan anticipates expanding the applications of intraoperative imaging with MR compatibility within the surgical theater and outside the traditional imaging suite.

“Bringing intraoperative MRI to other disease states will certainly require innovative solutions,” Flanagan noted. “For example, nearly 85 percent of neurosurgical procedures involve the spine. The challenge with imaging the spine is that you must insert the patient much deeper into the MRI scanner while carefully monitoring the patient and managing the sterile field, drapes, and anesthesia. One of the benefits of the current IMRIS MR neurosurgical table is that it doesn’t come into contact with the scanner, which greatly simplifies these challenges. However, the current table cannot reach deep enough into the scanner to enable the lower spine to be scanned.”

How about a self-driving table?

“In the near future, we anticipate that surgical tables will allow digital communication between the table and C-Arm,” Biodex Medical’s Schubert predicted. “Through this digital software enhancement, movement between the table and C-Arm will be integrated, moving together — like a self-driving car. This type of integration will help alleviate worries about damage to the table, keep the C-Arm from touching the patient, and simplify positioning.”

Tables connected to the Internet of Things (IoT) may drive innovation, according to Derrick.

“’Smart’ tables can now sync with software like the STERIS RealView to give surgeons better data during procedures,” he said. “It’s inevitable that the table and the navigation robots will be better linked in the future, both through software and likely as one seamless piece of equipment. The integration between multiple pieces of equipment isn’t that far off. Innovation in the way OR’s handle waste is constant; SERRES, a Finnish manufacturer of fluid waste management equipment, is introducing a new system this year called the NEMO. This is a replacement for the old ‘hopper’ systems present in many older ORs. This equipment makes it easier for clinicians to get waste from the surgical table and procedure area to the central waste repository. It may not be long until systems like the NEMO are integrated with the tables themselves.”

Noteworthy products

BIODEX:

The NEW Surgical C-Arm Table 840 from Biodex is designed for image-guided fluoroscopic procedures where stability, access, and precise, quiet, vibration-free positioning are essential. Latest model includes a stainless steel base, larger radiolucent area, exclusive SmoothGlide movement and isocentric lateral roll motion to help ensure a clear image.

IMRIS:

Image Diagnostics:

Brewer Company: