Small Animal Laparoscopy and Thoracoscopy. Группа авторов

Figure 3.12 Mobile cart equipped with NIR/ICG imaging system for laparoscopic and thoracoscopic procedures.

      Source: © KARL STORZ SE & Co. KG, Germany.

Integrated and Intelligent Operating Rooms

As the number of devices has increased in MIS, access to each piece of equipment has become a challenge, risking excessive circulation near or within the sterile area. This challenge led to the development of integrative software and hardware platforms, or the integrated room. The integrated OR concept is based on a single‐post control station near the border of the sterile area (Figure 3.13b), which allows a single operator to coordinate, manipulate, manage, and access all information by a network and integration software displayed on one or multiple screens [52].

      These integrative platforms optimize the space in the OR while establishing capabilities for teleconferencing and teaching. The internal connection with hospital data management programs and other imaging platforms such as PACS (Picture Archiving and Communication System) also permits surgeons inside the OR to access other diagnostic images simultaneously for navigation or decision‐making during procedures. Although costly, the ease of accessing and producing medical reports, data exchange, and storage can be advantageous in hospitals with large caseloads [53].

Operating Room Setup

      The optimal design of an OR has been widely discussed, and standards for OR construction have been published by the American College of Surgeons on the Operating Room Environment and the American Institute of Architects Committee on Architecture for Health. In veterinary medicine, no specific guidelines exist, so common sense and translations from human surgery are used. Several solutions are commonly proposed to reduce equipment crowding and cables or lines crossing the floor in the OR [54–56].

Preparation for Open Surgery

      All instrumentation for open surgery should be available in case conversion becomes necessary. The entire surgical team should be prepared for a smooth and expedient transition [9,57–64].

      Considerations for a Minimally Invasive Theater or Suite

      With the advent of minimally invasive, image‐guided laparoscopic procedures and other enhanced visualization and guidance systems, PACS and electronic medical records, the demands and needs for different qualities, types and intensities of light, as well as variations of brightness and focus in the different zones around the room have become primary functional and design challenges and concerns. Lighting systems today must provide flexibility in terms of intensity in the level and movement of light in the space, so that the system can adapt to the different requirements of open surgery, MIS, or image‐guided procedures. The need for different lighting in different zones within the OR to support the specialized functions during the procedure, and the complexity of the integrated OR control systems has added an additional level of complexity beyond what was seen even in the recent past.

      The room must accommodate at least two equipment towers (endoscopy and anesthesia), and space must allow for their free movement to either end of the surgical table. Also, adequate clearance from the patient is required to avoid breaks in sterile technique. Ideally, two to three monitors are positioned either on booms, the equipment towers, or separate wheeled carts [55–58].