By Roman Gross and Faye Casey
Recenttechnological developments in imaging and surgical instrumentation have improvedthe operating process. Surgical procedures of the future will become faster,safer, and less stressful. While operating tables with features that might beconsidered novel are being developed, basic requirements for the presentgeneration of surgical tables continue to increase. In addition to the evolutionof procedures from invasive to non-invasive, which demand that patients bepositioned differently, requirements also are driven by human factors, such astaller and heavier patients. All new technological innovations have the samegoal in mind--improved patient care.
More surgery is being performed in an outpatient surgery setting than everbefore. As more complex procedures work their way into the outpatient ORs, theneed for surgical tables to handle a variety of procedures/positions now becomesmore important than ever. In this ever-changing world of surgical procedures andsettings, current surgical table technology is evolving to meet needs identifiedtoday--and to anticipate the procedures of tomorrow.
Today's surgical suites are busy, often to the point of overload. What impactdoes this have on surgical table design? Surgical tables must be flexible and beable to handle a wide variety of procedures and specialty disciplines that mayrequire numerous patient positions. Many surgical suites have a variety ofsurgical tables--different models, from different manufacturers--because theywere purchased over the course of many years. Since some tables are moresuitable for the newer procedures than others, tables need to be mobile, andeasily transferred from one OR to another.
During the past decade, there have been many technological advancements forthe improvement of surgical tables. They range from features as simplistic asself-leveling floor locks to compensate for the uneven floors often found inolder ORs, to a "return-to-level" function that will return the tableto flat by activating a button. Both of these developments served to improve theperformance of OR tables; the first by providing a stable surface for thesurgeon, and the second by providing the ability to return the patient to a flatposition for transfer at the end of the procedure.
Power tables are now often battery-operated, eliminating the need forelectrical cords on the floor. Most surgical tables are equipped withradiolucent tabletops to enable them to be used with C-arm imaging equipment.Many of these features are considered to be standard, and surgical tables beingintroduced today incorporate a number of innovative features designed to improveperformance capacity in all areas of the surgical procedure. Because of the needto accommodate heavier patients, some models have a weight capacity of up to 800pounds. The modular construction of some OR tables allows them to be adjusted tothe body size of the individual patient. Tables are designed to reach lowerheights, sometimes required in certain non-invasive procedures, which permit thesurgeon to work easily while seated. Another trend is toward more user-friendlycontrols. Power surgical tables assist the OR team in positioning the patientthrough 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 acable-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 LCDdisplay. Some newer models have hand controls that display the actual degree ofthe range of specific functions, allowing the position to be repeatableaccording to the surgeon's preference. Others have individually programmablesettings for the table position, which can be controlled from the wall controlpanel.
Improvements are not limited to the surgical table. New procedures demand newpositioning devices, resulting in numerous new table accessories. Some aredesigned to facilitate specialty procedures, such as shoulder surgery. Inaddition, table pads are made of new materials designed to eliminate pressuresores.
Surgical suites in the US have almost always been designed with a mobile ORtable in mind. In the rest of the world, however, surgical suites are frequentlydesigned to incorporate an operating table system, which forms a new standard inthe OR. The system concept allows the positioning surface of the operating tableto be separate from the table support column, which is firmly fixed to thefloor. The advantage is a higher patient turnaround in the OR, because thepatient remains on the positioning surface after the operation; the wholesurface is removed from the column by means of a transporter and is taken out ofthe operating room with the patient. Meanwhile, the next patient, alreadyanesthetized, is outside the operating room on a second positioning surface andcan immediately be brought into the vacated OR. The patient remains in the ORonly for the period between the incision and suture. This efficiency-enhancingprinciple may be described as a "rational patient roundabout."
This operating table system design is making its way into US hospitals. Thesystem requires an entirely new mind-set for the surgical staff, and the designof the surgical suite must be modified in order to accommodate it. Sincepatients are typically anesthetized prior to being moved into the OR and takenfrom the OR before they have regained consciousness, areas to perform thesefunctions and/or monitor the patient must be dedicated. But there are manybenefits of this system. The patient is transferred to the surgical surfacedirectly 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 isthen transported into the OR following removal of the previous patient and roomcleanup, the surgical surface and patient are placed on the surgical tablecolumn, and the transporter is removed from the room. When the procedure iscomplete, the transporter is returned to the room, the table top and patienttransferred to the transporter and removed to an area where the patient will bereturned 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. ORturnaround 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 radiologywill grow closer together. Image monitoring will be a basic requirement in moreintense future use of both interventional and minimally invasive procedures inradiology and surgery. The rapid expansion of endoscopic procedures is atpresent causing a rise in the complications rate. One reason for this is thatimaging during the operation is either impossible or of insufficient quality.X-ray diagnostics using a mobile C-arm or a stationary system mounted on theceiling or floor supplies sufficient information only in high-contrastsituations ( e.g., vessels filled with a contrast medium or bones).Computer tomography imaging can better depict anatomic distinctions inlow-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 moreprecisely. When diagnosis, operation, and subsequent procedural control can alltake 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 AdvancedWorkplace for Image Guided Surgery--a system that integrates diagnostics,surgery, and patient monitoring without transferring the patient. The systemconsists of an operating table and a computer tomograph (CT), and the areas ofapplication for this system are extremely numerous. For example, a tumor can becompletely and definitively removed. Before, during, and after the operation thesurgeon can use the images from the CT to plan his intervention, update the basedata of the navigation system, and immediately control the results. This hasbeen nearly impossible to date because of the spatial separation of surgery andCT radiology. In the future, this system is foreseen for use in neurosurgery andorthopedics, as well as in general surgery, as well as in trauma, oral, andorthodontic surgery.
In the trauma setting, this system saves time. The patient is placed on aradiation-permeable carbon fiber mat, which is used multifunctionally for thetransporter, operating table, and interface with the CT. The otherwiseunavoidable, extremely stressful repositioning of the patient can be avoided. Atpresent, a patient may be moved up to 12 times in these often high-riskprocesses from the time they are brought to the hospital until they aretransferred to intensive care. From the transporter, which also serves as thetreatment table for initial treatment, the patient can be pushed gently in theCT for diagnosis--remaining at all time on the same surface. If immediatesurgery is indicated, it can be undertaken at once on the directly connected ORtable.
Another advanced system, VIWAS (Vascular Interventional Workplace forAdvanced Surgery), was developed especially for procedures on the heart andcoronary vessels: from bypass to dilatation. The positioning surface of thistable, which is constructed of carbon fiber material, can be shiftedlongitudinally and laterally. The surface and patient are moved, by motor, tothe desired position making it possible, for example, to precisely follow thecourse of the vessels.
This new system follows a hybrid concept of new OR techniques opening upthrough interdisciplinary cooperation. Radiology and surgery work hand in handto optimize the process and providing the highest of quality assurance for thepatient. As a platform for all vascular procedures, in the future it will allowplacement of stents to be performed in the operating room instead of the cathlab. Should an emergency arise, the patient can be immediately operated on.
All of these concepts show the progress in the development of operatingtables, the new medical possibilities which technological innovations create,and point the way to the future of surgery. Through videoconferencing, surgerycan now be performed in one location and broadcast to an audience thousands ofmiles away, to tap into the availability of specialists, for educationalpurposes, or for a number of other reasons. From mobile tables to a surgicaltable system, the integrated operating room of tomorrow will incorporateradiology as well as surgery in the same setting. As ORs evolve, so will thesurgical table.
Roman Gross is director of product marketing, surgical tables, forGetinge/Castle, Inc., N. Charleston, SC. Faye Casey is manager of marketingcommunications for Getinge/Castle, Inc., Rochester, NY.