CHAPTER 114

The Operating Room Suite and Instrumentation

Many functional, uncluttered, and multidisciplinary systems are available to help organize an operating room suite. Most instruments can be placed on carts or booms, which can be moved to accommodate the surgical site (Figs. 114–1 and 114–2). An operating suite does not have to contain all commercially available instruments to function properly. The basic instruments that are required for safe laparoscopic surgery can be divided into three groups: the electronic cart, the laparoscopic instrument table, and the vaginal instrument table.

Electronic Cart

The following instruments are usually placed on the electronic cart (Fig. 114–3):

Monitor

Light source

Camera and camera control unit

High-flow insufflator

Electrosurgical unit

Image recording device

The monitor can be on the cart as shown. Recently, the flat screen monitors are separate units.

A three-chip camera will give higher resolution than a one-chip camera. This will be noticed only if the monitor has the same number of lines of resolution. A xenon light source (300W) gives better illumination and color duplication than a halogen (150W and 300W) one. All insufflators have flow and pressure controls. The pressure should always be set at less than 15 mm Hg. Higher settings are rarely needed and should be used for brief periods of time. High-flow insufflators will render small leaks less important. An electrosurgical unit that has both unipolar and bipolar systems should be used. The unipolar system should generate both nonmodulated (cutting) and modulated (coagulation) current. The bipolar instruments will have the source current on a prong of the forceps or scissors and the return electrode on the other prong. In the unipolar system, the instrument is the source of the current, and the return electrode is the grounding pad.

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