Surgical lights, tables and workstations: OR staples that steal the show
By Jeannie Akridge
Surgical lights and tables, while a staple component of any
OR, are anything but basic. Advanced technologies are bringing new functionality
to these necessities like never before.
Integrated OR
Many of the larger suppliers who provide both lights and
tables, such as Skytron (Grand Rapids, MI), and BERCHTOLD Corporation, wth a
U.S. base in Charleston, SC and European headquarters in Germany, are now making
the transition to integrated operating room capabilities that can include voice
and touch screen activation, video monitors, cameras, power booms and more for
an OR that is both efficient and multi-functional. Other lights and tables
vendors that offer integration features to some degree include STERIS
Corporation (Mentor, OH); Stryker Corporation (Kalamazoo, MI); TRUMPF Medical
Systems, an international company with U.S. headquarters in Charleston, SC; and
multi-national Getinge, Inc. with a U.S. base in Rochester, NY. ConMed
Integrated Systems (Portland, OR) offers its Smart OR™ integration capabilities
with the Nurse’s Assistant® OR control system.
Integrated OR suites can be custom-configured to be as
minimal or extravagant as the customer desires, whether retrofitted or built
from scratch.
Skytron
Integrated OR
"There are different levels of an integrated OR. It can be
something as simple as sharing video from the surgical camera inside the
patient’s body, and illuminating the image on a monitor," said Randy Tomaszewski,
vice president, marketing of Skytron. "Most hospitals want to have the video
component of integration because it provides a lot of benefits to the surgical
team. The minimally invasive equipment program could also be of interest to
hospitals to have on the integration platform. If you want to go further you can
add layers depending on what the surgical team desires. It’s more of an
investment as you
move up the chain."
Berchtold says its Supersuite® capabilities are configured
with the help of the company’s on-staff clinical specialists who analyze the
hospital’s surgery schedule to determine best-case scenarios and then design the
OR accordingly. John Nies, Berchtold’s Product Manager for Teletom® Power Booms
and Chromaphare® Surgical Lights, explains that while most new construction
projects he’s seen involve at least minimal components of integration, such as
lights, booms and flat panels, those that take integration to higher levels of
importing and exporting images in and out of the OR, are typically limited to
larger teaching hospitals.
Additional integration capabilities include pushing PACS
images from radiology and cath lab films; video display through anesthesia
telemetry products; and teleconferencing with doctors in other offices or
cities.
Tomaszewski says the ability to switch those images from one
monitor to another at the surgeon’s preference is an important feature of
integration.
BERCHTOLD Supersuite®
"You can take it one step further and add touch screen or
voice activation control at a remote location and at the surgical field with
sterile capabilities of the surgeon to change the insufflator, and change the
light source setting which is specific to the minimally invasive equipment
company’s equipment," said Tomaszewski. Both say that it’s especially important
to work closely with vendors such as the minimally invasive equipment company
early on in the planning stages of an integrated OR.
Comments Nies, "The more integrated you get, the more the
companies have to work together to make sure the end result package comes out
smoothly and works properly."
Lighting systems
Much more than simply a light source, today’s lighting
systems are tailor-designed to accommodate specific surgical procedures and a
wealth of features.
Major surgery lights
Though driven by a variety of technologies, major surgery
lights are designed with basic principles in mind: a soft white light that is
high intensity, low heat, true color, with shadow reduction and without glare.
Options include single, double and triple lighthead configurations in wall,
ceiling and stand mounts. Illumination of 100,000 lux at a distance of one meter
from the light source is the minimum required
by the Illumination Engineering
Society of North America; some lights provide well over that. Consider a light’s
rotation capabilities; many rotate 360 degrees at the lighthead axis, while
others are even more flexible. Many lights can be voice and touch-screen
activated, and have the option of incorporating cameras, flat panels and
monitors. Look for lights made of lightweight, yet durable materials that
provide drift-free capabilities.
Skytron’s Stellar Surgical Lights are focusable lights that
provide direct focus and variable depth of field control, while retaining 90% of
maximum intensity at any distance. Tomaszewski explains that surgeons are able
to actually move the column of light up and down, with a quarter-turn of a
sterile handle, while the column of light maintains its intensity.
BERCHTOLD Chromaphare®
Berchtold has a new lighting system (model X65) that uses a
technology called "gas discharge lighting". As Nies explains, instead
of heating a filament, a canister of gas is ionized to emit light. One advantage
is that there are no physical parts to fail over time because of heating and
cooling. More importantly, the gas discharge lights use only a 70 watt bulb, (as
compared to a typical 150 watt bulb) that produces very little heat yet packs a
big
punch
with 160,000 lux. In addition, says Nies, the light is very close to natural
sunlight at a color temperature of 4500K. Trumpf also has a lighting system it says works on a gas
discharge technology. Also at 160,000 lux with a 70-watt bulb, is the XENION
light, a combination of Xenon gas and halogen technology. Xenion lamps have a
lifetime of 5,000 working hours.
TRUMPF XENION®
Getinge offers its ALM lighting systems in several models.
The PrismAlix series features micro-prism refractive technology in which
diverging, overlapping light beams create a column of evenly distributed light.
The suspension system provides not only 360-degree rotation at each pivot
access, but also 210-degree movement on an Automatic Compensation System (ACS).
The Angenieux series offers a cross-shaped lighthead plus a combination of
filters and mirrors to keep the lights cool.
Stryker says its Visum™ Surgical Lights that come standard
with five pole commutators, versus three, at all 360-degree rotational points
provide a cleaner data and video signal transmission. Its StrykeCam™, with
high-zoom capabilities can be incorporated into the Visum.
Stryker Visum™
The Harmony™ LA surgical lighting system from STERIS features
Wavelens™ technology which the company says provides super-
focus capability, and
a
Cold Mirror Reflector for shadow control and depth of field. The system has an
LCD control center that compensates for fluctuations in power supply and
performs self-diagnostics.
Steris Harmony
Burton
Visionary®
Burton Medical (Chatsworth, CA), which touts its
competitively priced lighting systems, offers the Genesis® Plus and Genie™ Plus
series which provide 160,000 lux at 4000K color temperature with a continuous
dimming feature. Burton says its compact Visionary® major OR light allows ORs
with limited budgets to upgrade to an advanced surgical lighting system.
Medical Illumination International (San Fernando, CA) offers
its System One lighting series which it says provides many of the features of
major surgical lighting with a lower
Medical Illumination System One
price tag.
Minor surgery lights
Burton XenaLux™
Many of the major lights and tables vendors provide versions
of ambulatory surgery lights that are less expensive, more compact, and do not
provide the intense illumination of major surgery lights. There are several
companies that exclusively provide exam lights and minor surgery lights.
Skytron’s ST1919 model is a less intense version of the
Stellar lighting systems that features 19" lightheads.
Skytron Stellar
The Celestial Star from Sunnex, Inc. (Natick, MA) can be wall
or ceiling mounted and has 359-degree rotation from both horizontal and vertical
planes.
Sunnex Celestial Star™
Welch Allyn (Central NY) offers its LS-200™ procedure light
with wall mount or mobile stand that features a three-lamp design for
shadow-free illumination.
Headlights and minimally invasive surgery
Minimally invasive surgery requires a different breed of
lighting systems. One option is a headlight system, a luminaire positioned
directly between a surgeon’s eyes to provide clear, shadow-free illumination
that can penetrate deep into a narrow opening.
WelchAllyn SFI Headlight
Welch Allyn offers the largest selection of surgical
headlights, from battery-operated LED versions to high-intensity lights.
According to David Tufenkjian, Sr. Product Manager for Welch Allyn, "We’re the
only company that has single fiber headlights. Instead of a bundle of glass
fibers numbering in the thousands, we have a headlight system that uses a single
1.4 mm plastic fiber that’s
extremely
lightweight."
He also explains that its single fiber headlights have the
exclusive feature of increasing the density of the light as the spot size is
reduced. "It concentrates the light into a smaller spot using optics," explains
Tufenkjian. "Multi-fiber illumination and other products use an aperture to make
the hole smaller where the light comes out, so you’re not increasing the amount
of light, you’re only masking out anything larger than the desired size."
Burton offers its XenaLux™ 300-watt xenon-powered headlamp
which uses translucent polymer multi-fiber cables. An extremely bright light of
120,000+lux, the XenaLux includes a three-year warranty.
The DeepSite™ Fiber Optic Light from STERIS provides an
alternative to headlights with over 100,000 lux and a spot size of two to six
inches. The DeepSite can be positioned with one hand at distances of 15 to 22
inches from the incision. Because the light is not tethered to the surgeon, it
allows freedom of movement.
Built into the dome of Berchtold’s lightheads is the Endolite,
which provides a low-level ambient light reflected from the ceiling. Once the
surgeon turns off the regular lighting system to view the video monitor, the
Endolite provides enough light to see, without interfering with the monitors.
Soon to be released is Getinge’s X-ten ALM lighting system.
510K pending, the X-ten features LED lights inside that can be switched on for
ambient lighting during minimally invasive
surgery.
GetingePrismAlix®
Surgical tables
Table options vary not only in the types of procedures that
can be formed on them, but also in weight-load capacities, imaging capabilities,
patient transport, mobility functions and accessory options. Look for tables
that provide full-function tilt, trendelenberg, reverse trendelenberg and other
positioning capabilities. Another
convenient feature to consider is removable
leg sections.
General purpose tables
Berchtold’s Operon® surgical tables provide versatility in a
table that can lift
and articulate 600 lbs. The Operon features 12" longitudinal
slide, carbon-fiber tabletop with a 21" wide surface area. A back-lit pendant
allows vision of controls during low-light surgeries. The battery-operated table
lasts through between 50 and 70 procedures. Says Allan Hattey, Clinical
Specialist with Berchtold, "The B10 is one surgical table that will satisfy the
needs of all surgical specialties."
Skytron 3500 Series
Skytron has its 3500 Series surgical table which features 21"
of top slide, accommodates 500 lbs., and according to Tomaszewski, provides
extreme flexibility without a lot of extra accessories or extensive patient
pre-positioning. "It gives you a super bang for your investment dollar," he
says. Tomaszewski claims that the Skytron tables typically last between ten to
fifteen years with no more than a couple of service visits per year.
The CMAX table from FHSurgical, based in Hendersonville, TN,
features a 600-lb. capacity, 18" of longitudinal slide, easy mobility with four
swivel casters, complete accessories, plus a compact motorized kidney elevator.
Auto Limit Sensors™ prevent sectional conflicts and table collisions, while an
LCD readout on the hand control shows the exact degree of elevation
and table
positioning. The CMAX includes a Touch ID™ screen which can store information
and serve as a tutorial of the table’s features and operation. An E-Serve™
feature connects to the FHSurgical technical network for diagnoses and equipment
repair.
FHSurgical CMAX
Bariatric tables
As more patients are reaching greater size, tables must
accommodate increasing weight-loads. Options in bariatric tables vary from
tables designed specifically for bariatric use to extensions that can convert a
hospital’s existing tables. Look for tables that can lift and articulate up to
1000 lbs; split-leg extensions that provide easier access to the surgical site;
plus wider tables and accessories to accommodate the bariatric patient. Imaging
capabilities will be important; and finally, consider a table with low-height
options.
Skytron’sHercules 6500HD Bariatric/General
Purpose Table, which can lift 1,000 lbs, and articulate 850 lbs., provides
full-body imaging
and 180-degree top rotation. The table includes optional side extensions to
widen the table up to 30".
Skytron
Hercules 6500 HD
Getinge’s MAQUET Alphamaxx surgical table provides 1000-lb. weight capacity with full articulation in both normal and reverse orientations,
which it says is designed to reduce patient positioning time by up to 30 minutes
per case.
GetingeAlphamaquet
STERIS
Bariatric Extensions
STERIS’s Amsco 3085 SP Surgical Table safely raises and
lowers patients of up to 1000 lbs. in both normal and reverse orientation. In
addition, STERIS offers carbon-fiber bariatric extensions for its Amsco
3080/3085 Surgical tables with a 28" width. For hospitals who want to save the
cost of a new table, STERIS suggests its Bariatric Accessory Package to enhance
the hospital’s existing tables. Sections feature Tri-Layer Technology pads that
provide comfortable support for heavier patients.
TRUMPF TITAN
Trumpf positions its TITAN universal operating table as the
"one table to meet all of your needs." The Titan is designed for complete
mobility even with patients up to 1000 lbs. It features remote control operation
for both patient transport and positioning. Trumpf says anesthesiologists like
the adjustment options of the head sections which ease intubation and ventilation of obese patients.
Image-guided surgery tables
With the move to minimally invasive surgery, it’s
particularly important for tables to have exceptional imaging capabilities. A
number of new options are emerging that can replace and surpass the technology
of traditional x-ray tops.
Berchtold’s Hattey describes the unique imaging capabilities
of the company’s Operon B810 table. "The technology we use has no x-ray top, and
the cassette is
introduced at either the head or leg section of the table,
through a channel that runs beneath the length of the table." One hundred
percent of the B810’s carbon-fiber tabletop is radiolucent, and because the
cassette is not introduced at the side of the table, the surgeon can continue to
operate while the image is taken. Hattey said this technology avoids many of the
headaches associated with cumbersome x-ray tops that require extra cleaning,
often scratch the table, and are an additional expense beyond the cost of the
surgical table. Hattey adds, "The picture is much clearer because you’re only
shooting through one top."
STERIS offers the SurgiGraphic™ 6000
Image Guided Surgical Table with 4-way float that allows the user to manually
glide the tabletop for precise positioning without moving the C-Arm.
Steris SurgiGraphic
Skytron’s Tomaszewski touts the "nose-to-toes" full-body imaging capabilities of
all of Skytron’s tables. Skytron’s 6600 General Purpose table has 210 degree top
rotation, which allows the surgeon to rotate the top of the table to clear the
base out of the way. The table has a removable leg section and back section,
either of which can be replaced with a 36" carbon fiber accessory for enhanced
imaging with no metal whatsoever with upper and lower body procedures.
Ambulatory surgery
For surgery centers pressed with cost considerations, a
selection of functionality-rich surgical tables exist. Berchtold’s
Operon B710 can lift and articulate 770 lbs., has split leg accessories,
exceptional imaging capabilities, and a carbon-fiber tabletop.
BERCHTOLD OperonB810
The ASC 2000™ Ambulatory Surgical Care Table from STERIS is a
general surgery table that features electro-hydraulic powered, full
anthropometric posturing, full range of accessories, plus it can accommodate
many previously owned accessories. Its radiolucent top and offset column allow
C-arm body imaging coverage over 85% of the table.
Skytron offers its 1700 Series Outpatient Surgery table with
a 500-lb. weight-load capacity, 180-degree top rotation for full-body imaging
and uninterrupted C-arm approach. The table has a one-touch pendant control.
Table systems
Among the more innovative approaches to surgery tables is the
operating table system, such as Getinge’s Alphamaquet tables that have been a
staple of efficient operating rooms throughout Europe. The operating table
system concept is still new to the U.S., but gaining momentum as surgery centers
look at ways to increase productivity.
The operating table system consists of interchangeable
tabletops docked to either a fixed or mobile column base via a maneuverable
transporter. The theory behind the table system is an improved workflow through
parallel perioperative processing.
According to Julie Shanahan, Manager, Marketing
Communications for Getinge USA, patients spend less time in the operating room,
on average about ten to fifteen minutes less. Intubation and post-operative
monitoring take place outside of the OR. The patient remains on the tabletop
pre-to-post-op, eliminating two transfers. The Alphamaquet includes a universal
tabletop for general surgery, and specialty-purpose tabletops for a full range
of procedures.
TRUMPF
JUPITER SYSTEM
Trumpf’s JUPITER system combines the principles of a universal
surgical table with an integrated patient transport solution. The patient is
moved on the Jupiter tabletop via the Jupiter system trolley. The shuttle is
aligned over the computer-controlled fixed column and the tabletop is secured
to the column by remote control. After the procedure, the patient is removed
from the OR on the tabletop via the shuttle system.
Patient transport systems
An important accompaniment to the operating table is the
patient transport system. In some cases, the transport system can double as a
surgery table.
Stryker Trio
Stryker Medical’s Trio® is a fully-functioning mobile surgery platform built
for use in pre-op, procedure and post-op in the outpatient surgery setting. Trio
supports a wide range of procedures, plus meets safety and comfort requirements
for prep and recovery. With the potential to eliminate two patient transfers,
Steve Ueland, Associate Product Manager for Stryker Medical, says the Trio is
"good for the overall experience of the patient and good for the safety of the
staff." He adds that the Trio can help speed up OR turnover, resulting in "one
or two additional procedures per day, depending on the cases, making the
facilities more profitable."
Trumpf’s
ORBIT PT works in conjunction with any Trumpf mobile operating table to
automate the patient transport process by allowing one nurse to transfer the
patient without lifting. The system involves a conveyance system controlled by
remote or control panel that moves the patient form the bed to the Orbit PT,
to the OR table and back again.
TRUMPF ORBIT PT
Workstations
Workstations are another component of the OR with multiple
identities and varying functionalities. You’ll find a mixed bag of OR-compatible
stainless steel centers to accommodate multiple needs, including to serve as a
control center for an integrated OR.
Skytron has a Mini Nurse Documentation Control Center
(NDC-48) designed to maximize space. In a 48" width, the Mini NDC48 provides
storage and integration control of critical communications equipment, video
switching control, PACS System Management, computer documentation, stereo and
other room controls.
Skytron Nurse Documentation Center
InnerSpace/Datel
(Grand Rapids, MI), has a Workstation Cart (Model 4390) which features locking
tambour doors on the upper and lower sections; stainless steel work surface; and
adjustable hooks on the back wall for packaged supplies.
InnerSpace Workstation Cart
InterMetro Industries Corporation (Wilkes-Barre, PA) offers a
variety of workspace/storage options including the Starsys™ Mobile WorkCenters,
which can be easily reconfigured to change function as well as moved to another
location. Metro WorkSpace™Adjustable Workstations provide additional options
that adjust in 3" increments to provide ergonomic work surfaces.
Skytron
Integrated OR
BERCHTOLD Supersuite®
BERCHTOLD Chromaphare®
Trumpf also has a lighting system it says works on a gas
discharge technology. Also at 160,000 lux with a 70-watt bulb, is the XENION
light, a combination of Xenon gas and halogen technology. Xenion lamps have a
lifetime of 5,000 working hours.
Stryker says its Visum™ Surgical Lights that come standard
with five pole commutators, versus three, at all 360-degree rotational points
provide a cleaner data and video signal transmission. Its StrykeCam™, with
high-zoom capabilities can be incorporated into the Visum.
Cold Mirror Reflector for shadow control and depth of field. The system has an
LCD control center that compensates for fluctuations in power supply and
performs self-diagnostics.
Burton
Visionary®
Medical Illumination International (San Fernando, CA) offers
its System One lighting series which it says provides many of the features of
major surgical lighting with a lower
Medical Illumination System One
price tag. 
Burton XenaLux™
The Celestial Star from Sunnex, Inc. (Natick, MA) can be wall
or ceiling mounted and has 359-degree rotation from both horizontal and vertical
planes. 
WelchAllyn SFI Headlight
Skytron 3500 Series
Skytron’sHercules 6500HD Bariatric/General
Purpose Table, which can lift 1,000 lbs, and articulate 850 lbs., provides
full-body imaging
and 180-degree top rotation. The table includes optional side extensions to
widen the table up to 30". 
Getinge’s MAQUET Alphamaxx surgical table provides 1000-lb. weight capacity with full articulation in both normal and reverse orientations,
which it says is designed to reduce patient positioning time by up to 30 minutes
per case.
STERIS
Bariatric Extensions 
TRUMPF TITAN
STERIS offers the SurgiGraphic™ 6000
Image Guided Surgical Table with 4-way float that allows the user to manually
glide the tabletop for precise positioning without moving the C-Arm. 
Berchtold’s
Operon B710 can lift and articulate 770 lbs., has split leg accessories,
exceptional imaging capabilities, and a carbon-fiber tabletop. 
TRUMPF
JUPITER SYSTEM
Trumpf’s
ORBIT PT works in conjunction with any Trumpf mobile operating table to
automate the patient transport process by allowing one nurse to transfer the
patient without lifting. The system involves a conveyance system controlled by
remote or control panel that moves the patient form the bed to the Orbit PT,
to the OR table and back again.
InnerSpace/Datel
(Grand Rapids, MI), has a Workstation Cart (Model 4390) which features locking
tambour doors on the upper and lower sections; stainless steel work surface; and
adjustable hooks on the back wall for packaged supplies.