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OPERATING THEATRES


theatre will also undertake a variety of general upper GI surgery, such as excision of gastric tumours, as well as urological procedures. Andy Marriott said of the practical challenges of constructing the new theatre: “It was challenging because, being an old- build, the space was tight with a low ceiling. Working with the Trust, we nevertheless successfully managed an extremely successful refurbishment here, and accommodated all the required equipment in an attractively finished, ergonomically- designed new integrated surgical facility where, to enhance safety and efficiency, there are no trailing cables, with the main control and other equipment stacks accessible off the floor, and where all equipment can be touchsreen-controlled. All the data needed to steam surgical footage – live or recorded – can be sent securely, in encrypted form, to its destination.” While currently the ‘links’ between the new theatre and the MacDonald Education Centre are hard-wired, Olympus Medical has incorporated the IP infrastructure to allow wireless streaming to other healthcare or indeed conference facilities once the surgical team determine that it wishes to start this. Andy Marriott said Olympus was delighted to have been asked by NHS Ayrshire & Arran to provide the ‘total turnkey’ theatre solution here. “Our team worked closely with both construction company, Cosco Construction, who undertook all the structural


refurbishment, and specialist mechanical and electrical contractor, Hiltons, who installed the lighting and pendants, and undertook a variety of electrical installation,” he explained. “We have excellent long-standing relationships with both companies, and know we can rely on their proven expertise.” The ‘refurb’ and refitting entailed extensive work to fit elements including new ceilings, flooring, electrics, and IPS and UPS components. Andy Marriott said: “We not only had to devise the optimal configuration, but also to consider equipment positioning, adjacencies, and workflow – for instance from the anaesthetic and ‘prep room’ to the theatre. “Sealing off the new theatre and opening up access from a corridor meant nothing had to go in or out through working clinical space. Cosco and Hiltons’ extensive experience of working in ‘live’ clinical areas proved a major advantage.”


Collaboration and efficiency


The entire project – from boarding off the existing theatre and strip-out, to full completion, with all equipment in situ – took just nine weeks. Andy Marriott said: “Complex fast-track turnkey projects like this require multidisciplinary collaboration to progress smoothly, and on this scheme the Olympus Medical team worked closely and collaboratively with everyone from the surgical and nursing teams who would use the new theatre, to Hotel and Catering staff, ‘Infection Control’, IT, and the NHS Ayrshire & Arran Estates and Facilities team. There were


MAY 2019


The Endoalpha control mechanism, and notably the Olympus Medical HomeScreen touchscreen control panel, offer surgeons an easy-to-use means of adjusting everything from the lighting levels, to the operation of the pendants.


regular and fruitful multidisciplinary, multi- party project meetings to iron out any issues.” The new Olympus Endoalpha 4K integrated theatre is now in use seven days per week. Andy Marriott said: The theatre is purpose-designed for laparoscopic surgery, but will also be used for some general procedures. Should NHS Ayrshire & Arran decide they wish to bring in additional interventional, endoscopic, or diagnostic imaging equipment to the theatre, it is future-proofed to facilitate this. It has been a fantastic project to work on, and we are proud of the very high quality of the new theatre, which we hope will enable the hospital’s surgical team to meet its strategic short and longer-term aims.”


The surgeon’s standpoint


Giving his standpoint on the advantages to himself and his surgical colleagues of the new theatre, Professor Majid Ali said: “The level of surgical detail and the extremely precise view of the operating field that the Olympus equipment affords are key. Elements that you cannot easily distinguish in open or ‘keyhole’ surgery become clear thanks to the 4K technology. “The integration of all the key equipment on pendants has greatly reduced the clutter you often see in theatre environments, which has significant benefits to both patients and staff. In the new theatre we are already undertaking some of the most advanced laparoscopic procedures in Scotland, and over time it will substantially increase our surgical capacity. “We already have referrals from as far away as Stornoway and Dumfries and Galloway. “What really stands out is that the new integrated theatre provides a super-safe and user-friendly space for effective surgical teamwork. We have also recently seen an increase in recruitment of surgical staff


wanting to work here, which will help spread our reputation for innovative surgery. The theatre’s enhanced capabilities will also allow us to be participate in international events that would previously have been difficult to get involved in.” Professor Ali explained that all surgeons wanting to specialise in laparoscopic surgery needed around eight years’ intensive training in the field on top of their existing surgical training, plus a one-year Fellowship. He added: “Hopefully we can encourage more such training here and perhaps establish a Fellowship at University Hospital Ayr. “One of our major activities in the integrated 4K theatre will be weight reduction surgery – particularly targeting people with Type 2 diabetes; we actually manage to reverse approximately 70% of such cases. We also undertake surgery for bowel cancers, and indeed the first patient I operated in the new theatre had a gastric volvulus, where the stomach permeated into the chest and became twisted. The patient was discharged on the third day after surgery. Had we done the option conventionally, making incisions in the chest and abdomen, and then returned to an HDU, the patient might not have survived. My own specialism is upper GI ‘keyhole’ surgery. There will be around seven surgeons in all here in Ayr using the theatre. We have trainees coming here from all over the region.” Chairman of Ayrshire & Arran and


Ayrshire NHS Board, Martin Cheyne added: “Walking into this theatre, it is indeed highly impressive. I myself am an engineer, and I know that 20 or 30 years ago, hospital operating theatres were very different places. “I am delighted that NHS Ayrshire & Arran has access to this state-of-the-art technology which, importantly, should lead to better patient outcomes, as well as better outcomes for recruitment and the sustainability of the service.”


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