Integrated operating rooms (I-ORs), when optimally designed, can lessen the complexity of the most complicated environment in the hospital—the surgery suite. User-friendly, integrated technologies augment surgeons' skills and help the entire surgical team work more safely and efficiently. The development and growth of minimally invasive surgery (MIS) has spurred the creation of I-ORs. Today, more than half the surgery cases in the United States are performed with minimally invasive techniques.
MIS requires only small incisions through which slender surgical steel tubes are inserted to route surgical instruments, cameras, aspiration tubes, lights, and air-management devices to the anatomy. A high-quality, magnified video, projected on a flat-screen monitor, gives the surgeon an optimal view of the surgical field (figure 1). The small incisions mean less pain, faster healing, and shorter hospital stays—or no hospital stay at all. As MIS continues to grow and robotic surgery and telemedicine become more common, I-ORs will become an industry standard, likely within the next few years.
A magnified video image, projected on a flat-screen monitor, gives the surgeon high-fidelity visualization of the surgery during a minimally invasive procedure. Photo: Karl Storz Endoscopy-America, Inc.
What Is an I-OR?
In the context of an operating room, “integration” refers to functionally connecting the OR environment. This includes patient information, audio, video, surgical lights and room lights, building automation (HVAC), and medical equipment. Users can easily route A/V sources and effectively control surgical equipment. When integrated, all technology can be manipulated from a central command console by one operator.
Compare that with the nonintegrated OR, where an assortment of equipment is arranged around the surgical table and individual pieces are pulled up or pushed back as needed. A circulating nurse works amid the equipment to change settings at the request of the surgeon—e.g., increase pressure on the insufflator, adjust the lighting, or capture an image. Cables and cords from the equipment lie in the path of the nurse, the patient gurney, and even under the feet of the anesthesiologist and the surgical team. There is a risk of tripping and disturbing the surgery, of pulling out wires, and of damaging equipment.
In an I-OR, cords and cables run inside the articulating arms of ceiling-mounted lights and booms through conduits in the ceiling. Ideally, there are no cords or cables on the floor to trip on or roll a cart over. The circulating nurse works from a console at a control station, where she has access via a computer to numerous devices in the room. No longer is she navigating the room during surgery. In fact, she is not even approaching the sterile field. All controls are on a touch screen, and the nurse can carry out the surgeon's requests from this common control station for all equipment. A surgeon may also have a command console within reach in the surgical field. Some systems even offer voice recognition and activation so that the surgeon, wearing a wireless headset with a microphone, can control the system directly.
Levels of Integration
VE level. I-ORs can be integrated at a variety of levels. At the minimal, or VE, level, video from medical equipment is fixed in the room. The video sources are images from the arthroscopic, laparoscopic, and endoscopic cameras. These video images are displayed on specific flat-panel monitors hung from the ceiling boom or on a cart near the surgeon. He views these while performing surgery. Music may be present in the room, but it is provided by equipment no more sophisticated than a boom box.
AVT level. Classic A/V and teleconferencing systems are at the AVT level of integration. These systems are used for conference room and auditorium presentations and may have music, television, and projection systems. They are typically provided by manufacturers of nonmedical devices.