Standard Operating Room Table Research Articles

Lateral Decubitus Positioning For Shoulder Arthroscopy

Background: Lateral decubitus positioning is a frequently employed technique to perform shoulder arthroscopy. Proper patient positioning and equipment setup is crucial to ensure a safe and efficient surgery. Indications: The common indications for performing a shoulder arthroscopy in the lateral decubitus position include anterior shoulder stabilization, posterior shoulder stabilization, superior labrum anterior to posterior (SLAP) repair, diagnostic arthroscopy for internal impingement, and arthroscopic capsular release for adhesive capsulitis. Technique Description: After undergoing general endotracheal anesthesia in the supine position on a standard operating room table, the patient is rotated into the lateral decubitus position with the operative arm facing upward. The patient’s head is supported with a pillow to ensure a neutral position. The nonoperative arm is flexed forward and rests on a padded arm board. The sides of a bean bag are applied to the patient’s torso to maintain the lateral decubitus position, and the bean bag is deflated to remain rigid. An axillary roll is placed under the axilla, and foam pads are placed below the “down leg” and between both legs. A commercial arm jack is positioned on the anterior, proximal side of the operating room table to allow for 20° of shoulder abduction, which maximizes the glenohumeral joint space. Results: Advantages of the lateral decubitus position over the beach chair position include improved access to the anterior, inferior, and posterior glenoid; more ergonomic positioning for the operating surgeon; lower risk for patient cerebral hypoperfusion; and reduced rates of recurrent instability following arthroscopic stabilization in comparison to procedures performed in the beach chair position. Disadvantages of the lateral decubitus position include risk of traction-related neurovascular injury, requirement of an arm suspension device, and increased difficulty in rotating the shoulder intraoperatively. Discussion/Conclusion: Lateral decubitus positioning is commonly used to achieve a circumferential view of the glenohumeral joint in shoulder arthroscopy. This surgical position yields several advantages for the operating surgeon and has been shown to be associated with improved clinical outcomes after shoulder instability surgery. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Methods for Reducing Intraoperative Breast Radiation Exposure of Orthopaedic Surgeons.

Standard lead aprons and vests do not adequately shield the most common breast cancer site, the upper outer quadrant (UOQ), from intraoperative radiation. The purpose of the present study was to determine if lead sleeves, wings, and/or axillary supplements decreased intraoperative radiation exposure of the UOQ of the breast. An anthropomorphic torso phantom (simulating the female surgeon) was placed adjacent to a standard operating room table. Dosimeters were placed bilaterally over the UOQ of the breast. Scatter radiation dose equivalent rates (mrem/hr) were measured during continuous fluoroscopy of a pelvic phantom (simulating the patient). Five protection configurations (no lead; lead vest; and vest with sleeves, wings, and axillary supplements), 2 surgeon positions (facing the table and perpendicular to the table), and 2 C-arm positions (anteroposterior and cross-table lateral projection) were tested. The t test was utilized with a Bonferroni correction for multiple t tests. Lead sleeves and axillary supplements decreased intraoperative radiation exposure to the UOQ of the breast when compared with a well-fitted standard lead vest alone (p < 0.01) across all surgeon and C-arm positions. The addition of wings decreased radiation exposure to a lesser extent than sleeves or axillary supplements, and the difference when compared with the lead vest alone did not reach significance (p = 0.29). Breast radiation exposure in the C-arm cross-table lateral projection was highest across all testing. The UOQ of the breast is not adequately protected by standard lead vests alone or vests with the addition of wings. Axillary supplements and sleeves improved protection of the breast. Modifications of lead protective vests may improve intraoperative breast radiation protection.

The Yoga Mat Technique in Postless Hip Arthroscopy

Hip arthroscopy for the treatment of femoroacetabular impingement syndrome with anti-sliding techniques and without the use of a perineal post to achieve hip distraction has increased greatly in the past 5 to 10 years. To access the hip joint, distraction is mandatory to treat intra-articular disorders such as labral tears, acetabular cartilage defects, loose bodies, ligamentum teres tears, and avascular necrosis of the hip. In hip distraction, counter-distraction is needed, and this is achieved with a bulky and cushioned perineal post. Most of the described techniques in hip arthroscopy worldwide use a perineal post, but iatrogenic pudendal nerve, genital lacerations, hematomas, and groin complications have been reported to occur. In Latin American countries, disposable hip pad devices are expensive, and not all the arthroscopic companies provide them. Our yoga mat technique provides enough countertraction to achieve adequate hip distraction. Labral repair, labral reconstruction, and decompression of femoroacetabular impingement syndrome have been achieved properly, reliably, and reproducibly, and no Trendelenburg position is needed. Postless hip arthroscopy is made simple, and positioning the patient is not difficult. Hip surgeons can adapt this technique to a fracture table, a hip distractor, and a standard operating room table.

Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

BackgroundIn the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications.Materials and methodsAll total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated.ResultsA total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences.ConclusionIn conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach.Level of evidenceIV.

Operating On a Stretcher Is a Safe Alternative to an Operating Room Table

Purpose: The primary purpose of this study was to compare intraoperative and post-operative complication rates for upper extremity surgical cases performed on a standard operating room (OR) table with similar cases done on a typical hospital stretcher. Secondary measures reviewed included surgical time, turnover time, total OR time, blood loss, tourniquet time, and postoperative complications. Methods: Using our institution’s electronic medical record system, we reviewed 100 consecutive upper extremity cases performed on a stretcher as well as 100 consecutive upper extremity cases done on a standard OR table. All cases were performed by the same board certified, fellowship trained orthopaedic surgeon. The cases were performed between February of 2014 and May of 2016 at a level one trauma center and its associated outpatient surgical center. Basic univariate statistical analyses were performed, and the two groups were compared for primary and secondary outcome measures. Results: The data showed no significant increase in intraoperative complication rates when operating on a standard hospital stretcher compared to operating on an OR table. There were a total of 6 postoperative complications in the stretcher group and a total of 11 complications in the OR table group. The most common postoperative complication seen in both cohorts was infection. There was one intraoperative complication in the OR table group and none in the stretcher group. With regard to total operating room time, surgical time, and delta time (overall OR room time minus surgical time which was used to calculate the turnover time), we found that the OR table group had shorter times in each category. The total OR time for the OR table group was a mean time of 105 minutes compared to 146 minutes seen in the stretcher group (p= 0.0002). Similarly, there was a shorter mean surgical time for surgeries done on an OR table (73 minutes) when compared to surgeries done on a stretcher (104 minutes) (p = 0.0026). Finally, the average turnover time (delta time) for the OR table group was 32 minutes while the average turnover time for the stretcher group was 42 minutes (p= 0.0002). The average tourniquet time for the OR table group was 36 minutes as compared to 41 in the stretcher group (p=0.467). Conclusion: Operating on a typical hospital stretcher is a safe alternative to operating on a standard operating room table as there was no increased complication rate seen with surgeries performed on a stretcher compared to an OR table.

Surgical technique of direct anterior approach for total hip arthroplasty on a standard operating room table

The direct anterior approach (DAA) for total hip arthroplasty (THA) is an increasingly popular surgical approach with numerous benefits cited in the literature. However, it is not without a well-documented “learning curve”, during which time potential difficulties can occur. This article outlines the authors’ technique of performing the DAA on a standard operating room table, with particular attention paid to technical specifics that may be helpful to the surgeon in performing this operation safely.

Direct Anterior Total Hip Arthroplasty.

In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane. Careful positioning is necessary to complete this procedure on a standard operating room table. Incise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels. The hip is flexed 30° during the deep dissection. Ream the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°. Use offset broaches to access the femur and prevent perforation through the greater trochanter. Specifically check for impingement of bone on the implant with the hip flexed 90°. This approach has been used successfully for total hip arthroplasty for decades. IndicationsContraindicationsPitfalls & Challenges.

Single-Incision Direct Anterior Approach for Total Hip Arthroplasty Using a Standard Operating Table

Minimally invasive joint arthroplasties have gained in popularity this decade for multiple reasons. Many different authors have described markedly different approaches to minimally invasive hip arthroplasties, and there is no consensus for a single definition of what is minimally invasive. The basic premise of minimizing soft tissue disruption would be best met by going through intermuscular and internervous planes to do the procedure. In hip arthroplasty, the direct anterior approach to the hip is the only such approach. This article will describe this technique using a standard operating room table rather than using a specialized fracture table.

A 4‐cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery

In this experimental study, a 4-cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29.5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure-reducing devices on the operating room (OR)-table should reduce the patients' interface pressure and thus the hazard of skin breakdown. A randomized controlled trial was performed to test the effect of a 4-cm thermoactive viscoelastic foam overlay with a water-filled warming mattress on the OR-table (test OR-table) compared with the standard OR-table (a water-filled warming mattress, no pressure-reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. The results show that patients lying on the 4-cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17.6%) than patients on the standard OR-table without the foam overlay (11.1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. The combination of a 4-cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.

The Effectiveness of Pressure-Reducing Table Pads as an Intervention to Reduce the Risk of Intraoperatively Acquired Pressure Sores

The purpose of this study was to determine the effectiveness of specialty pads as an intervention to reduce the incidence of intraoperatively acquired pressure sores. A convenience sample (N = 361) was drawn from all inpatients who underwent cardiothoracic or major vascular surgery on the standard operating room table (group 1), the air-filled pad (group 2), or the specialty foam pad (group 3). This sample was inclusive of 100% of patients during the study period who met the criteria. The incidence of pressure sore development was seven in group 1, zero in group 2, and one in group 3. There was at statistically significant difference (p = 0.0003) between group 1 and group 2. Additionally, a statistically significant difference (p = 0.0003) was found between group 1 and group 3. The foam pad and the air-filled pad were effective interventions for reducing the risk of intraoperatively acquired pressure sores.

Modified Stryker frame for intraoperative positioning of the patient with burns.

Positioning large patients with burns for prone burn procedures can be very difficult, requiring operating room personnel to use a gang-lift technique. We have used the upper portion of a Stryker frame mounted to a standard operating room table base in more than 200 burn procedures in adults to move patients from the supine to the prone position, and back, without complication.

Universal microsurgical operating table

A table designed to fit at 90° to or as a continuation of a standard operating room table provides a comfortable position for the operating microsurgeon working on the head, neck, trunk, or extremities.