Operating Room Arrangements

The Basic Operating Room Arrangements -  As stated above, the arrangement of the equipment and personnel in the operating room is very important for an efficient workflow during neurosurgical procedures.

The diagrams below are very cursory and certainly do not cover every acceptable or conceivable variation. They are meant as suggestions and as a guide to teach how the operating room can be arranged to maximize efficiency. Both right- and left-handed setups are represented for general cranial, general spinal, and endonasal/transsphenoidal cases. More specific arrangements for specialized neurosurgical procedures are not covered but can be gleaned from the principles illustrated by the diagrams.

In all cases, the neurosurgeon’s handedness is addressed by having the scrub nurse or technician immediately next to the surgeon’s dominant hand, so passage of instruments proceeds without obstruction. However, as mentioned above, variations can and do exist. Two particular variations worth mentioning are prone and lateral decubitus positions. In prone cases, the scrub nurse or technician may be across the patient from the surgeon, so that instruments are passed directly to the neurosurgeon instead of from the side.

Some feel this may allow better visual communication between the scrub nurse/ technician and the neurosurgeon. In the lateral decubitus position, the position of the patient’s face, and hence access to the airway, is fixed, giving the anesthesiologist limited positioning, even after extended ventilation tubing is put into place. The surgical scrub nurse or technician and the surgical assistant will more than likely be placed on the same side of the body.

The important characteristic here is to always give the anesthesiologist a route to the airway such that crises can be averted. In the end, the arrangement is up to you or the facility that employs you. The important thing is to realize that there is a basis for where equipment and personnel are placed in the operating room (Table 1.1) (Figs. 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8 and 1.9).

Table 1.1 Operating Room Setup Legend

A – Anesthesia Ae – Anesthesia Equipment C – Accessory Equipment I – Surgical Instruments M – Microscope S – Neurosurgeon s – Assistant Neurosurgeon Sn – Scrub Nurse or Tech

 

 
Fig. 1.2 General right-handed surgeon supine or posterior fossa craniotomy setup (cranial approach).

Fig. 1.3 General right-handed surgeon posterior fossa craniotomy setup (caudal approach).

Fig. 1.4 General right-handed surgeon spine procedure setup.

Fig. 1.5 General right-handed surgeon endonasal/transsphenoidal setup.

Fig. 1.6 General left-handed surgeon supine or posterior fossa craniotomy setup (cranial approach).

Fig. 1.7 General left-handed surgeon posterior fossa craniotomy setup (caudal approach).

Fig.1.8 General left-handed surgeon spine procedure setup.

Fig.1.9 General left-handed surgeon endonasal/transsphenoidal setup.