Jane Hendricks: RGN, Bsc (hons), Msc.Jane Hendricks: RGN, Bsc (hons), Msc.

Surgical Care Practitioner: Laparoscopic SurgerySurgical Care Practitioner: Laparoscopic Surgery

Integrated Laparoscopic Operating TheatresIntegrated Laparoscopic Operating Theatres

Essex Rivers Healthcare NHS TrustColchester General Hospital

WhyWhy

Current stack system to heavy to Current stack system to heavy to move, moving and handling.move, moving and handling.

Wiring system and button pushing Wiring system and button pushing complicated.complicated.

Having to individually set each piece Having to individually set each piece of equipment, turn around times.of equipment, turn around times.

The Tardis!The Tardis!

As you can see very As you can see very complicated.complicated.

Problems when picture Problems when picture in picture is requiredin picture is required

To many opportunities To many opportunities for baby technos to for baby technos to interfereinterfere

Which button do I press Which button do I press next?next?

Shall I plug this in Shall I plug this in here?here?

What We Have NowWhat We Have Now

Health and safetyHealth and safety

Problems with old style theatres Problems with old style theatres trailing cables, heavy equipment to trailing cables, heavy equipment to manoeuvre.manoeuvre.

Reduced patient accessReduced patient access Having to set up each individual piece Having to set up each individual piece

of equipment.of equipment.

Computerised communication towerComputerised communication tower SCB- Storz Communication Bus, future SCB- Storz Communication Bus, future

proofed.proofed. AIDA-advanced image and data archiving, AIDA-advanced image and data archiving,

allows video editing, printing and part of allows video editing, printing and part of EPR.EPR.

Media Control- powerful tele video Media Control- powerful tele video conferencing system and transmission of conferencing system and transmission of images, can be used for telemedicine, images, can be used for telemedicine, telementoring and remote teachingtelementoring and remote teaching

Integrated Operating TheatreIntegrated Operating Theatre

State of the artState of the art Scrub team controlledScrub team controlled Links together via interface, all Links together via interface, all

surgical equipment including op table, surgical equipment including op table, room lights, diathermy, etc.room lights, diathermy, etc.

Future proofed, important.Future proofed, important.

AdvantagesAdvantages

Being boom mounted is important as Being boom mounted is important as this much safer for equipment.this much safer for equipment.

Easier for staff to move, health and Easier for staff to move, health and safety.safety.

Enables us to position monitors where Enables us to position monitors where they are required.they are required.

Trailing cables are removed from floor.Trailing cables are removed from floor.

AdvantagesAdvantages

Ease of use for all theatre staff.Ease of use for all theatre staff. Training time: by the end of two Training time: by the end of two

weeks regular staff where happy to use weeks regular staff where happy to use system on their own.system on their own.

Touch screen enables circulator to Touch screen enables circulator to change settings without entering sterile change settings without entering sterile field.field.

AdvantagesAdvantages

Having the system all wired and Having the system all wired and mounted to the ceiling means that mounted to the ceiling means that people can’t borrow it!!people can’t borrow it!!

Trouble shooting is much less complex Trouble shooting is much less complex as once system is set up less to go as once system is set up less to go wrong, in theory !!!!!wrong, in theory !!!!!

Stops hybrid systems being used so Stops hybrid systems being used so always get best quality image.always get best quality image.

LocationLocation

As some equipment can be remote As some equipment can be remote located less equipment in theatre.located less equipment in theatre.

Infection control issues etcInfection control issues etc Computers are now smaller and as we Computers are now smaller and as we

now have flat screens the equipment now have flat screens the equipment occupies a smaller area.occupies a smaller area.

Advantages: remote controllerAdvantages: remote controller Allows the scrub person to alter settings Allows the scrub person to alter settings

and become more self sufficient less and become more self sufficient less people in theatres these days.people in theatres these days.

Better as allows you to alter many other Better as allows you to alter many other settings including light control, safety settings including light control, safety issue.issue.

- user friendly, as not on stand .- user friendly, as not on stand . -however need extra drape.-however need extra drape.

DisadvantagesDisadvantages

Training and competencies, however Training and competencies, however all specialities have new equipment.all specialities have new equipment.

Team approach ever more important, Team approach ever more important, lap surgery is a team effort.lap surgery is a team effort.

Initial stages reliant on company for Initial stages reliant on company for problem solving until experience problem solving until experience gained.gained.

Getting funding!!Getting funding!!

Future AspirationsFuture Aspirations

DVD writer to store moving images DVD writer to store moving images on, storage still an issue.on, storage still an issue.

Facility to always record the images.Facility to always record the images. Infra-red to remove the cables.Infra-red to remove the cables. ?voice activation of real benefit, ?voice activation of real benefit,

especially in times of stress!!!!.especially in times of stress!!!!. More equipment to be remote located.More equipment to be remote located.

Hand InstrumentationHand Instrumentation

Take apart instruments, cleaning, Take apart instruments, cleaning, reasonable cost less than £500 per reasonable cost less than £500 per instrument.instrument.

Telescopes all 5 mm, 30 degree.Telescopes all 5 mm, 30 degree. Basic needs for colorectal op Johannes Basic needs for colorectal op Johannes

X 2 and ultrasonic shears (multi X 2 and ultrasonic shears (multi purpose grasper, coagulate and cut, purpose grasper, coagulate and cut, dissect dissect

Operating TablesOperating Tables

Maquet ALM table.Maquet ALM table. Suitable for bariatric surgerySuitable for bariatric surgery Split leg, health and safety , only put Split leg, health and safety , only put

legs up when you need to, good for legs up when you need to, good for patient and surgeon.patient and surgeon.

Table interfaces with OR1.Table interfaces with OR1.

CostingsCostings

Ileocaecal resection £655.00Ileocaecal resection £655.00 Right hemicolectomy £516.36Right hemicolectomy £516.36 Left hemicolectomy £435.00Left hemicolectomy £435.00 Subtotal colectomy £740.00 Subtotal colectomy £740.00 Sigmoid Colectomy £611.15 Sigmoid Colectomy £611.15 Anterior resection £1062.50 Anterior resection £1062.50 Abdominoperineal £755.00Abdominoperineal £755.00 Restorative pouch £1355.00Restorative pouch £1355.00

Blood Loss (51 patients).Blood Loss (51 patients).

40 cases laparoscopic < 100mls.40 cases laparoscopic < 100mls. 5 cases, 4 lap 1 conv: 105-500.5 cases, 4 lap 1 conv: 105-500. 3 conv: 3 conv: 1050-15001050-1500 3 cases laparoscopic not recorded3 cases laparoscopic not recorded

Team WorkingTeam Working

Invest in Theatre teamInvest in Theatre team ERP programme to realise real cost ERP programme to realise real cost

benefitbenefit Needs to be a Trust wide adoption of the Needs to be a Trust wide adoption of the

technique.technique. Get the anaesthetist on side!Get the anaesthetist on side! Work with another colleague, surgeon, Work with another colleague, surgeon,

moral support.moral support.

AcknowledgementsAcknowledgements

Professor Roger MotsonProfessor Roger Motson

Mr. Tan AruampalamMr. Tan Aruampalam

Mr Ralph AustinMr Ralph Austin

Thank You For your Time.Thank You For your Time.