"Surgical tables designed to meet the needs of the baby boomer population and beyond require the ability not only to provide a wide range of patient lift and articulation capacity (a minimum of 500 lbs.) but also provide increasing imaging windows from ‘nose to toes’ for the many types of surgical procedures that require C-arm imaging," commented Randy Tomaszewski, vice president of marketing, Skytron.

Dave Rector, director of marketing communications, TRUMPF Medical Systems, identified the need for intra-operative imaging capabilities as one that "will continue to grow in importance. Carbon fiber components, head-to-toe imaging access and optimal positioning are being recognized as vital in terms of efficiency and better patient outcomes," he said.

In particular, noted Tomaszewski, "Top slide is one of the leading general purpose surgical table features sought after in consideration for optimizing surgical procedure capabilities in today’s operating rooms."

Skytron’s original 3500 Top Slide Table – the first to incorporate top slide capabilities within a fully functional, general purpose design – was a result of "listening closely to our clinicians and solving clinical set-up, patient positioning and C-arm imaging problems in the operating room," said Tomaszewski. The next generation Skytron UltraSlide 3600 provides heavy-duty patient weight capacity of 1,000-lb. lift and 800-lb. articulation, as well as the industry’s longest top slide overall range of 23 inches, that "allows patients undergoing surgery to quickly and conveniently be positioned for the best C-arm images during procedures at the touch of a button versus physically repositioned by surgical staff to optimize image windows."

"One of the things we noticed when we talked with customers is their desire to reduce those non-productive times in the OR cycle," related Eric Wittine, senior product manager, surgical tables, STERIS Corporation. In response, the Company recently introduced the STERIS 5085 SRT (sliding, rotating and transporting) General Surgical Table. Featuring an intuitive data-rich hand control, central weight-bearing drive wheel and 360° pivot mode, the STERIS 5085 SRT table was the first of its kind to be cleared by FDA for transport of patients throughout the perioperative suite by a single caregiver.

Accommodating a range of surgeries from advanced imaging procedures and minimally invasive surgical techniques, to traditional open surgeries, the STERIS 5085 SRT table is a self-contained unit that eliminates the need for gurneys and trolleys, reduces the number of patient transfers in the surgical suite and minimizes costly downtime.

"The productivity benefits that this product offers are related to the customer’s ability to perform parallel processing," said Wittine. For example, while the OR is being cleaned up and prepared for the next case, another patient could be on a 5085 SRT in the pre-op holding area receiving the initial stages of anesthesia. "If they can gain minutes in that cycle, that’s a good thing," he remarked.

Rector noted that intraoperative imaging, C-arm access, modular configurations and flexible easy positioning are all also important features for a table to be used in a hybrid surgical suite. "Today, different technologies, information systems, imaging modalities, and surgical teams from various disciplines are being integrated," described Rector. "In hybrid rooms, surgery and diagnostic procedures, commonly done in separate venues and a day apart, are performed in a single room without delays and without adding demands on patients and families. Feedback to the surgical team is immediate and procedures can be corrected and adjusted, often without the need for a second intervention. The melding of cardiac cath labs and cardiac ORs is one example."

Another example is TRUMPF’s BrainSUITE iCT intra-operative 3D imaging solution that integrates the BrainLAB navigation system, radiolucent TRUMPF JUPITER surgical table and Siemens SOMATOM CT scanning system.

The VERTIER Surgical Table is an integral part of Stryker’s Integrated Operating Room, or i-Suite. Vertier combines increased weight capacity and mobility with the versatility of a modular table top with 16 inches of top slide.

The MAGNUS Operating Table System from MAQUET offers extreme articulations including ultra-wide adjustment ranges for ergonomic access as well as unique x-ray capabilities.

"Hybrid OR solutions are becoming increasingly commonplace in contemporary healthcare facilities and new construction projects," said Tomaszewski. "Clinicians require more versatile environments that can enable them to carry out complex minimally invasive procedures with the flexibility to perform both open and complex MIS procedures in the same room. The cutting-edge hybrid room solution allows physicians to address patient needs quickly, eliminating the hassle of scheduling additional surgical procedures. Hybrid operating rooms provide versatile solutions that can further save hospitals critical time and flexibility to perform open, minimally invasive and high-risk diagnostic cases involving cardiovascular, orthopedic spine, neurosurgical and vascular procedures in the same room; with the additional flexibility to utilize the operating room space for general purpose surgical procedures when the clinical space is not being used for complex procedures requiring use of a C-arm and specialty imaging table.

Midmark 630 Barrier-Free Universal Power Procedures Table

"Hybrid rooms require a surgical table that can communicate automatically with the C-arm," he continued. "However, hybrid rooms when not being used for dedicated high-risk cases, can be quickly converted to general ORs. We are already collaborating with select C-arm suppliers to potentially provide this future option. For now, our tables are highly sought after when they convert hybrid rooms to full function surgical rooms as the present C-arm dedicated tables do not have the full function capabilities that ours do."

"The biggest challenges within ORs today continue to focus upon set-up time and safety of table positioning flexibility with the sufficient power to execute smooth articulations reliably and efficiently," said Tomaszewski. "ORs are rarely dedicated to any one type of procedure, but must be capable of handling a wide variety of cases and surgical specialties. OR tables are no exception. The ability for a table to quickly and easily be positioned for neurosurgical, vascular, general, cardiovascular and orthopedic cases and the time required to set up for these cases can be a key contributor to efficiency and throughput, or lack thereof," he said, adding, "the trend toward top slide and removable components (back and leg sections) have greatly increased efficiency today as opposed to even five years ago."

"Top slide and low table height are also key sought after advantages for clinical applications such as robotic surgery, bariatrics, vascular, ENT, hand and general surgery for seated surgeons," he noted. "Low table height permits surgeons access to exceptionally ‘thick’ patient torsos (i.e. bariatrics) without back strain and permits comfort for seated surgeons for ENT, neuro and hand surgery, etc. without having to contend with the table base. Likewise top rotation equipped tables also eliminate constraints of table clearance and provide free space for C-arm access as well as permitting surgeons to stand closer to their patients during surgical procedures without back strain."

The first to introduce a dedicated bariatric table to the healthcare market with the Hercules 6500HD, Skytron released the Hercules 6701 in January 2008, with key surgical table features of low height, 1,200-lb. lift and 1,000-lb. articulation, removable back and leg sections, 210-degree top rotation, 23-inch low table height, and more.

Wittine, STERIS, emphasized that low table height is essential for robotic surgeries. As surgeons seek shorter recovery times and improved patient outcomes, "we’re seeing greater use of minimally invasive surgical techniques, particularly for bariatrics," he said. "When you inflate the abdomen for a bariatric case, you need that table surface to get a little lower so that it can accommodate the arms of the robot easily above the patient’s operative site."

The STERIS 5085 SRT provides a 1,200-lb. weight capacity for patients at normal orientation centered over the column, 1,000-lb. for articulation at normal orientation, and 600-lb. for articulation and slide. Self-leveling floor locks compensate for irregularities in the OR floor and bring the table to a stable position.

Tomaszewski described how Skytron’s 4-point safety interlock system automatically activates when any button is selected on the Skytron Surgical Table hand control – leveling the table to the floor at all four corners of the table base, before the patient is articulated/moved in any way. The system then safety interlocks the brakes at all four corners making the surgical table base immobile and secure to the floor. The Skytron Hercules 6701 and the Elite 6002 tables provide a distinct advantage with the ability to offer top rotation without unlocking the brakes, while the EZSlide 3501 and UltraSlide 3600 offer top slide capabilities with brakes locked. According to guidelines from the Association of periOperative Registered Nurses (AORN), "surgical table brakes should never be unlocked once a patient is positioned on the surgical table," noted Tomaszewski.

Accessories and extensions that add to a surgical table’s flexibility are becoming more advanced with intuitive designs that allow general purpose surgical tables to serve additional functions in a flash.

BERCHTOLD Corporation now offers a Spine System Extension that converts any OPERON operating table into a spinal surgery table. Not only does the Spine System Extension cost about a third of the price of a standard Jackson spinal surgery table, it’s also much easier to store, noted Alvin Mayshack, OPERON product manager. "Jackson tables are very long. They’re not used for every case, of course. So what ends up happening, you walk into many hospitals where they’ve purchased Jackson tables, and they’re sitting out in the hall because they don’t store very easily." The Berchtold Spine System Extension, including accessories, stores on its own frame in about a 3-ft. square space.

With prone, lateral, and supine positioning, the Operon Spine System allows the abdomen to hang free and provides clear visibility, plus unrestricted C-arm access. The Flex Frame feature of the spine extension offers the ability to perform both anterior and posterior intra-operative lumbar flex to open up the spaces in the spine, something previously achieved only with the addition of a Wilson frame to the Jackson table, or the use of an Axis Jackson table. Wingset cushions push up against the chest area and hip area to support patients in prone and lateral positions.

The Operon spine system supports new and emerging surgical procedures such as DLIF, TLIF, and increasingly popular XLIF surgeries. "Spinal surgery is moving towards going into the spine from the hip versus going in through the front or back," commented Mayshack. With much less damage to muscles and nerves, patients are often released the following day after an XLIF surgery, he noted.

"The spinal frame gives you the best of both worlds," added Mayshack. "You have the capability to do everything that you would need to do with spinal situations, and still have a general purpose surgical table that you can use with the other 95 percent of the cases."

The T3 Spinal Frame, developed in collaboration with Allen Medical Systems, is a radiolucent, completely portable system that converts the TRUMPF JUPITER Carbon Fiber table to a fully functional spine table. Significantly less expensive than a traditional spine table, the T3 offers ease-of-use, excellent imaging capabilities and a high level of patient comfort and safety. Soft, contoured, layered foam pads with disposable low-shear covers and independently adjustable positions provide safe, comfortable and secure support for patients of all body types. Carbon Fiber makes the T3 radiolucent throughout the imaging area. The secure, free-hanging positioning of the patient and the table’s motorized X-Y slide combine with the T3’s open design to provide unobstructed views. The dimensions of the JUPITER tabletop and the T3’s proprietary armrests allow positioning that delivers superior intra-operative scanning in iCT suites.

The TRUMPF ARCH Table Extension is an economical, leg-holding traction device that’s placed at the foot end of any brand of surgical table to facilitate surgeries such as Anterior Total Hip Replacement – an approach gaining in popularity due to reduced hospital stays and improved patient recovery times – through advanced and easy patient positioning. The ARCH can also be used for hip and femur fracture cases and hip arthroscopy.

Stryker VERTIER surgical table

With the patient’s foot positioned in the ARCH’s traction boot, the foot and traction boot are connected to—and move along—the device frame, reducing the need for additional surgical team members to assist with positioning. "Optimal leg positioning, including hyperextension, abduction and external rotation, can be achieved with constant, measurable, safe traction and precise reference points," said Rector. These references points provide added efficiency by allowing procedures to be easily reproduced. "By allowing intra-operative measuring of limb length and range of motion the surgical team can be assured of a better outcome," he said.

Skytron’s Carbon Fiber 40-Inch Extension provides enhanced positioning for vascular and endovascular procedures. This accessory is placed on the surgical table for either upper or lower body imaging prior to placing the patient on the table with the convenient and easy to remove back and leg sections of the Skytron 6701 and 3600 surgical tables. A powered shoulder arthroscopy positioner can be quickly added to the back section (vs. leg section) and eliminates any interaction with the table base, providing surgeons with "obstacle-free" access to the patient’s affected shoulder and the ability to stand closer to the patient during the surgical case; which eliminates surgeon back strain. "Skytron surgical tables provide superior articulation control with a one-touch control of the back-lit table pendant vs. having to utilize a separate control to position the patient," said Tomaszewski. "All of this cuts down on surgical time, maximizing throughput and creating more time block potential openings for the O.R. for an additional case(s) per day."

STERIS offers a full range of accessories, including a shoulder chair attachment that becomes an integral part of the table and offers single-touch positioning, as well as a variety of surgical pressure management table pads. The interchangeable accessories are compatible with the complete line of STERIS tables.

Thanks to advances in anesthesia as well as minimally invasive surgery techniques, "care is migrating from a higher level setting to a lower level setting," noted Steve Cordonnier, product manager, medical procedure products, Midmark Corporation. "A surgical procedure that would have normally been done in the hospital OR 10 or 15 years ago might now move out into the ambulatory surgery setting; one that was done in the ambulatory surgery setting might now move into the physician’s office."

"Because of this growing trend in care migration," explained Cordonnier, "our procedures tables have to meet those needs. Midmark procedures tables are now more advanced, and we continue to add new features to benefit both the physician and the patient."

TRUMPF ARCH table extension

Midmark’s 630 Barrier-Free Universal Power Procedures Table offers power height, back, foot and tilt, while an adjustable headrest affords versatile head-and-neck positioning to accommodate a variety of outpatient procedures. The 630 Barrier-Free table can be lowered to a seat height of 19", allowing even wheelchair-bound patients to easily access the table.

While the Midmark tables don’t provide some of the capabilities reserved for full-function surgical tables – such as imaging, lateral tilt or reverse Trendelenburg – they do offer a host of other features designed to facilitate in-office procedures. "The overall capital expenditure is far less than for a full-featured surgical table," said Cordonnier. Options for 350° rotation at the touch of a pedal, programmability for automatic positioning recall, and a wireless hand control help enhance functionality.

Because patients are often given local anesthesia or conscious sedation after they are on the procedures table they are fully aware of their surroundings as they walk into the procedure room or ambulatory surgery room, versus being wheeled into the OR already under sedation. To help put patients at ease, Midmark has equipped the table with a variety of comfort features, including a chair-like feel achieved with a patented Premium Comfort System and even a heated upholstery option. "We made the product much more comforting to the patient, much more aesthetically pleasing, so that the physician who is moving procedures into an in-office surgery suite can now have a much more comforting environment," said Cordonnier.