Chapter 1: The Operating Room No guide to neurosurgical instrumentation would be complete without first discussing the operating room itself. While the instruments covered in this guide are used in the performance of neurosurgical procedures, the equipment in the operating room itself can also be thought of as instrumentation, involved in the workflow of the operation (Fig. 1.1). Knowledge of the operating room, its setup, and the basic equipment in the room before the patient rolls into the room will always improve the efficiency of the operating process. Most operating rooms have a basic set of equipment and areas where the different personnel of the operating room staff complete their intended tasks before, during, and after every surgical procedure. That knowledge, along with awareness of the roles of each person in the operating room, further improves the workflow so that communication and tasks can be performed without delay, especially in times of potential crisis. In this chapter, we will review some of the basics regarding the operating room staff, general equipment in the operating room, and finally, basic operating room setups that are commonly used for neurosurgical procedures. Most neurosurgical procedures that take place in the operating room, or “theatre” as it is called in the United Kingdom, Australia, and other countries, involve a team of people with defined roles, so that every need encountered during the procedure is met. Most operating room staff include a circulating nurse, a surgical technician or nurse, an anesthesia team (some with neuroanesthesia specialists) that may consist of an attending, fellow, CRNA, medical student, resident, and/or anesthesia technician, and finally, the surgical team itself, which may have several members, such as neurosurgery attending (s), residents, medical students, fellows, etc. Other accessory personnel who may be in attendance in the operating room include other medical students and residents not directly involved in the case, equipment or other industry representatives aiding in the use of specialized equipment, neurological monitoring technicians or staff, X-ray technicians, and pathology or laboratory staff awaiting tissue samples. The placement of each team member must be carefully considered before the procedure begins, so that no member hinders the operation or other workflow processes during the case. To ensure an efficient operating room, including all of the personnel mentioned above, the operating room must be set up so that all the team members and the equipment involved have specific places in the room. There are an infinite number of arrangements for the operating room, but a fundamental set of considerations must be addressed. Most operating rooms have supply rooms or closets that are located either in an adjacent room (s) or in cabinets within the operating room itself. These equipment areas should be accessible during the case without disturbing the surgeons and their team. The operating room table should also be set up to ensure that the transfer of surgical instruments between the surgeon and the surgical tech/nurse is comfortable and unhindered. The operating room setup should also place the anesthesiologists so that they have unfettered access to the patient’s airway and vascular access lines. Further, the handedness of the surgeon must also be considered when the room is set up for a particular neurosurgical procedure to ensure that the exchange of surgical instruments can occur with precision and without obstruction. Lastly, and certainly important for the purposes of this guide, is the placement and setup of the surgical instruments that will be accessed by the surgical scrub technician or nurse throughout the procedure. Other minor considerations that must also be addressed are the placement of the surgical microscope, the cauterization power supply and pedals, the surgical drill pedal, suction tubing, and similar equipment. In the next section, several basic operating room setups will be reviewed.
Operating Room Personnel
Operating Room Setup
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