New Developments in Surgery Foster Surgical Table Technology Improvements
By Roman Gross and Faye Casey
Recent technological developments in imaging and surgical instrumentation have improved the operating process. Surgical procedures of the future will become faster, safer, and less stressful. While operating tables with features that might be considered novel are being developed, basic requirements for the present generation of surgical tables continue to increase. In addition to the evolution of procedures from invasive to non-invasive, which demand that patients be positioned differently, requirements also are driven by human factors, such as taller and heavier patients. All new technological innovations have the same goal in mind--improved patient care.
More surgery is being performed in an outpatient surgery setting than ever before. As more complex procedures work their way into the outpatient ORs, the need for surgical tables to handle a variety of procedures/positions now becomes more important than ever. In this ever-changing world of surgical procedures and settings, current surgical table technology is evolving to meet needs identified today--and to anticipate the procedures of tomorrow.
Today's surgical suites are busy, often to the point of overload. What impact does this have on surgical table design? Surgical tables must be flexible and be able to handle a wide variety of procedures and specialty disciplines that may require numerous patient positions. Many surgical suites have a variety of surgical tables--different models, from different manufacturers--because they were purchased over the course of many years. Since some tables are more suitable for the newer procedures than others, tables need to be mobile, and easily transferred from one OR to another.
During the past decade, there have been many technological advancements for the improvement of surgical tables. They range from features as simplistic as self-leveling floor locks to compensate for the uneven floors often found in older ORs, to a "return-to-level" function that will return the table to flat by activating a button. Both of these developments served to improve the performance of OR tables; the first by providing a stable surface for the surgeon, and the second by providing the ability to return the patient to a flat position for transfer at the end of the procedure.
Power tables are now often battery-operated, eliminating the need for electrical cords on the floor. Most surgical tables are equipped with radiolucent tabletops to enable them to be used with C-arm imaging equipment. Many of these features are considered to be standard, and surgical tables being introduced today incorporate a number of innovative features designed to improve performance capacity in all areas of the surgical procedure. Because of the need to accommodate heavier patients, some models have a weight capacity of up to 800 pounds. The modular construction of some OR tables allows them to be adjusted to the body size of the individual patient. Tables are designed to reach lower heights, sometimes required in certain non-invasive procedures, which permit the surgeon to work easily while seated. Another trend is toward more user-friendly controls. Power surgical tables assist the OR team in positioning the patient through a number of motor-driven functions, like adjustment of height, tilt, back and leg supports, Trendelenburg, kidney elevation, and return-to-level. These motions can be controlled from different operating elements, such as a cable-connected hand control, IR-transmitter remote from the table, foot pedal, a control panel on the column head, and/or a wall control panel with an LCD display. Some newer models have hand controls that display the actual degree of the range of specific functions, allowing the position to be repeatable according to the surgeon's preference. Others have individually programmable settings for the table position, which can be controlled from the wall control panel.
Improvements are not limited to the surgical table. New procedures demand new positioning devices, resulting in numerous new table accessories. Some are designed to facilitate specialty procedures, such as shoulder surgery. In addition, table pads are made of new materials designed to eliminate pressure sores.
Surgical suites in the US have almost always been designed with a mobile OR table in mind. In the rest of the world, however, surgical suites are frequently designed to incorporate an operating table system, which forms a new standard in the OR. The system concept allows the positioning surface of the operating table to be separate from the table support column, which is firmly fixed to the floor. The advantage is a higher patient turnaround in the OR, because the patient remains on the positioning surface after the operation; the whole surface is removed from the column by means of a transporter and is taken out of the operating room with the patient. Meanwhile, the next patient, already anesthetized, is outside the operating room on a second positioning surface and can immediately be brought into the vacated OR. The patient remains in the OR only for the period between the incision and suture. This efficiency-enhancing principle may be described as a "rational patient roundabout."
This operating table system design is making its way into US hospitals. The system requires an entirely new mind-set for the surgical staff, and the design of the surgical suite must be modified in order to accommodate it. Since patients are typically anesthetized prior to being moved into the OR and taken from the OR before they have regained consciousness, areas to perform these functions and/or monitor the patient must be dedicated. But there are many benefits of this system. The patient is transferred to the surgical surface directly from his or her hospital bed, transported to an induction room where, at the proper time, he or she will be anesthetized. The unconscious patient is then transported into the OR following removal of the previous patient and room cleanup, the surgical surface and patient are placed on the surgical table column, and the transporter is removed from the room. When the procedure is complete, the transporter is returned to the room, the table top and patient transferred to the transporter and removed to an area where the patient will be returned to consciousness. There are some major benefits to this system. First, patients only have to be transferred once before and once after an operation, making transfer easier and less stressful on both patients and OR staff. OR turnaround time is minimized, resulting in maximum productivity and efficiency, and operating rooms can be used flexibly for all types of surgery.
In the operating room of the future, the disciplines of surgery and radiology will grow closer together. Image monitoring will be a basic requirement in more intense future use of both interventional and minimally invasive procedures in radiology and surgery. The rapid expansion of endoscopic procedures is at present causing a rise in the complications rate. One reason for this is that imaging during the operation is either impossible or of insufficient quality. X-ray diagnostics using a mobile C-arm or a stationary system mounted on the ceiling or floor supplies sufficient information only in high-contrast situations ( e.g., vessels filled with a contrast medium or bones). Computer tomography imaging can better depict anatomic distinctions in low-contrast areas and delivers the greatest geometric precision at present, above all in real-time displays.
By using image-guided diagnostic procedures, operations can be planned more precisely. When diagnosis, operation, and subsequent procedural control can all take place on one operating table surface, vitally important time can be gained, since seconds can be critical in surgery.
All of these factors have led to the development of AWIGS--the Advanced Workplace for Image Guided Surgery--a system that integrates diagnostics, surgery, and patient monitoring without transferring the patient. The system consists of an operating table and a computer tomograph (CT), and the areas of application for this system are extremely numerous. For example, a tumor can be completely and definitively removed. Before, during, and after the operation the surgeon can use the images from the CT to plan his intervention, update the base data of the navigation system, and immediately control the results. This has been nearly impossible to date because of the spatial separation of surgery and CT radiology. In the future, this system is foreseen for use in neurosurgery and orthopedics, as well as in general surgery, as well as in trauma, oral, and orthodontic surgery.
In the trauma setting, this system saves time. The patient is placed on a radiation-permeable carbon fiber mat, which is used multifunctionally for the transporter, operating table, and interface with the CT. The otherwise unavoidable, extremely stressful repositioning of the patient can be avoided. At present, a patient may be moved up to 12 times in these often high-risk processes from the time they are brought to the hospital until they are transferred to intensive care. From the transporter, which also serves as the treatment table for initial treatment, the patient can be pushed gently in the CT for diagnosis--remaining at all time on the same surface. If immediate surgery is indicated, it can be undertaken at once on the directly connected OR table.
Another advanced system, VIWAS (Vascular Interventional Workplace for Advanced Surgery), was developed especially for procedures on the heart and coronary vessels: from bypass to dilatation. The positioning surface of this table, which is constructed of carbon fiber material, can be shifted longitudinally and laterally. The surface and patient are moved, by motor, to the desired position making it possible, for example, to precisely follow the course of the vessels.
This new system follows a hybrid concept of new OR techniques opening up through interdisciplinary cooperation. Radiology and surgery work hand in hand to optimize the process and providing the highest of quality assurance for the patient. As a platform for all vascular procedures, in the future it will allow placement of stents to be performed in the operating room instead of the cath lab. Should an emergency arise, the patient can be immediately operated on.
All of these concepts show the progress in the development of operating tables, the new medical possibilities which technological innovations create, and point the way to the future of surgery. Through videoconferencing, surgery can now be performed in one location and broadcast to an audience thousands of miles away, to tap into the availability of specialists, for educational purposes, or for a number of other reasons. From mobile tables to a surgical table system, the integrated operating room of tomorrow will incorporate radiology as well as surgery in the same setting. As ORs evolve, so will the surgical table.
Roman Gross is director of product marketing, surgical tables, for Getinge/Castle, Inc., N. Charleston, SC. Faye Casey is manager of marketing communications for Getinge/Castle, Inc., Rochester, NY.