OPERATING THEATRE DESIGN
one of the key elements being the theatre light, typically in the centre of the theatre, located over the patient and surgical zone. Another key element is the anaesthetic pendant, generally ceiling mounted, which supplies the medical gas and electrics, predominantly to the anaesthetic machine on one side of the pendant or patient. At the table’s other end is a surgeon’s pendant – designed to run all the controls and the equipment the surgeon needs to operate.”
Minimally invasive procedures Scott Pickering explained that with more and more of today’s minimally invasive surgery, this required mounting equipment such as endoscopic devices to the pendants, to control the endoscopic equipment, and sometimes the AV too. He said: “If we start integrating AV solutions, and different types of laparoscopic surgery, the theatre team need to be able to see the images. As you can see, it is fairly easy to mount a monitor to a central operating light stem that you can see here in the picture – giving you nearly 360- degree rotation around the centre of the surgical site, enabling one person to view the images from an endoscopy device or a clinical information system. “However, more than one person may need to view these images, and surgeons and theatre teams tend not to want to look anywhere other than straight ahead; thus being able to position the light to rotate 360 degrees around the patient is very important, but unfortunately, the way operating lights are designed, it’s unlikely, traditionally, that you will get more than one independent monitor ono a central light stem; we thus need to be able to mount monitors in different areas of the theatre. One way is to add monitor arms to the pendants, onto the sort of the infrastructure solution we have in the ceilings. We offer three monitor mounts that we can install. We could incorporate even more housings, but there is then the potential for too much infrastructure in the ceiling, given that there will be ventilation and medical gas systems and other support structures in the ceiling voids.
Optimal solution
“As we have said, this is not particularly financially viable from the start – because if you have a number of operating theatres in a suite, designing them all for that capability from day one will be too expensive.” Scott Pickering continued: “So, what can we offer as a solution? In fact, we can design the operating theatre lights with the ability to add monitor arms or cameras, designing this into the original installation. We can simplify this by designing the monitor arms and light arms with the cameras to be sufficiently flexible to install cameras or cable systems at a later date.” ‘Traditionally’, he added, operating light monitors tended to be very
54 Health Estate Journal August 2021
Brandon Medical scheduled its installation team from Nigeria, Roko Engineering, to support the main contractor on the installation of 32 operating theatres and ICU beds at the new 2,500-bed Mulago Hospital in Kampala, Uganda.
difficult – once installed – to be able to add monitoring cables or cable systems and power supplies to.
Flexibility from pendants Turning to pendants, Scott Pickering explained that these often had a support structure built into the ceiling. He said: “Many have tended to be solo, in a single console type arrangement, and installed on a solo cavity spacer. However, if we design into the building structure at the original construction stage a tandem arrangement, at a not much higher cost than a solo structure, build that into the system, and install it, we could still install the solo pendant at ‘day one’. This then affords the flexibility that, 2-3 years down the line, when the theatre’s use perhaps changes from general surgery to trauma – which might need AV capabilities, requiring additional pendants and monitors – we can upgrade the pendant solution from a solo pendant to a solo pendant plus monitor arm.” This, he said, would be both easy to do, and inexpensive. He elaborated: “You’re only really paying for the additional monitor arm, as opposed to a huge building project entailing removing the original structures, redrilling, and adding extra power, just to add a monitor arm. “Equally, if we add into the ceiling cavities the video cables from the operating light to the pendants, and from the pendants to the walls, again, we’ve built in an infrastructure we can use in the future, that doesn’t cost a huge amount extra to put in at the building construction stage. Traditionally, we may try to save the money by not adding monitor power supplies into the ceiling, but if we do, and just put a socket up there, we can easily upgrade and add monitors.”
Referring to surgeon’s control panels, he said: “With these, again, we have the ability to add monitor arms or camera systems, and we can easily upgrade the software to accept monitor or video systems now coming from the theatre.”
Modern AV systems
The ‘final part’ of a modern operating theatre, Scott Pickering explained, tended to be the audio-visual components. He said: “If we’ve built in our fibre cable runs from the operating light to the pendants to
the control panel and the PACS system, it becomes very easy to add an AV solution. So, how would we do this in tandem with operating lights? You can see that we have a structure, perhaps in the ceiling, where we could potentially mount power supplies to, or coil AV cabling solutions into the ceiling above the theatre. Then, if we needed to gain access subsequently, we could remove the ceiling shrouds, and pull the cables down and through the monitor arms and connect the monitors to the power supplies. We would work similarly with the ceiling support structures for the pendants. You can see on this slide a solo cavity spacer, with its connections, but all we would need to do would be to upgrade to a tandem cavity spacer, perhaps by drilling an extra couple of holes in the ceiling to fix it in place – a very easy upgrade at the building construction stage, but something that’s nigh on impossible to do later on, once the theatre has been completed.
Multifunction racks
“We also need to make the pendants flexible. One way we do this is using our multifunction racks – our way of mounting theatre equipment and accessories. We have a twin pole arrangement using two 38 mm poles for mounting all our equipment. We don’t need to change the column itself; it can stay as compact as possible. The multifunction rack poles can be extended as long as we need them to be, to mount accessories, so it’s very easy to upgrade for new equipment – we can add very easily to the pendant columns. “Flexibility is the key. So, in the future, we’re pretty sure that any new devices that emerge with the new technologies will mount to either poles or the many rail systems we can have on our pendants. While we’re keen to keep the pendant console as compact as possible, due to its modular design, we may also be able to upgrade it too. The upshot of all we have discussed is that with the flexibility and adaptability of our equipment, and its modular design, the customer can start out with a very simple theatre, but over time transform it into a very complex one.” This concluded a very interesting presentation.
hej
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