the past decade, digital image capturing systems have effectively made SLR cameras, video cassette recorders (VCRs), and video printers obsolete. When trying to capture images directly to a computer, most practitioners face some limitations directly related to the outputs on the CCU and monitor and the inputs of the computer itself. Software compatibility may also be an issue. The ultimate image quality and user friendliness are critical factors [1–5, 13].
Newer sophisticated digital capture systems (Figure 3.11) offer 4K and FULL HD 3‐D image quality and easy export of data to the hospital network or patient files. Most units also have an internal storage of limited volume, including patient‐related information. Still images and videos are captured and stored on the unit's hard drive or alternatively recorded onto USB flash drives, CD‐ROM/DVD, or external devices.
Figure 3.11 Digital capture and archiving system with integrated touch screen. Modern units allow recording FULL HD, 3D, and 4K signals.
Source: © KARL STORZ SE & Co. KG, Germany.
Some endoscopic camera systems contain an integrated capture system (Figures 3.9b). These integrated systems lack some of the features of independent image capture and archiving systems [1–5]. However, they are useful for simple documentation when more sophisticated digital capture systems are not available.
Video Carts and Ceiling Booms
Mobile equipment carts (Figure 3.12) are essential for MIS. A multi‐shelf wheeled cart is a common choice, which contains multiple electrical outlets for the equipment and insulated wheels which fulfill the electrical safety standards for medical equipment. The cart may also accommodate peripheral arms or stands for auxiliary screens and other devices (e.g., touch screen for digital capture or integrated software platforms) and drawers to store accessory instrumentation such as cables, filters, tubing, etc. [1–5, 8]
New hardware and design concepts help organize the OR, keeping flooring free from cables and easing cleaning and sterilization. Ceiling‐mounted movable arms or tracks can conveniently position equipment near the patient while freeing the floor space around the operating table. Ceiling booms can be fixed or movable by means of suspended racks and are highly advantageous in the OR. They provide integrated electrical connection as well as access to gas lines and suction (“air‐pods”), and they provide shelves and drawers. Other less complex ceiling booms support surgical illumination and auxiliary screens, which are standard in modern MIS suites. Disadvantages mainly include cost and specific installation requirements.
Figure 3.12 Mobile cart equipped with NIR/ICG imaging system for laparoscopic and thoracoscopic procedures.
Source: © KARL STORZ SE & Co. KG, Germany.
Integrated and Intelligent Operating Rooms
As the number of devices has increased in MIS, access to each piece of equipment has become a challenge, risking excessive circulation near or within the sterile area. This challenge led to the development of integrative software and hardware platforms, or the integrated room. The integrated OR concept is based on a single‐post control station near the border of the sterile area (Figure 3.13b), which allows a single operator to coordinate, manipulate, manage, and access all information by a network and integration software displayed on one or multiple screens [52].
These integrative platforms optimize the space in the OR while establishing capabilities for teleconferencing and teaching. The internal connection with hospital data management programs and other imaging platforms such as PACS (Picture Archiving and Communication System) also permits surgeons inside the OR to access other diagnostic images simultaneously for navigation or decision‐making during procedures. Although costly, the ease of accessing and producing medical reports, data exchange, and storage can be advantageous in hospitals with large caseloads [53].
Operating Room Setup
The optimal design of an OR has been widely discussed, and standards for OR construction have been published by the American College of Surgeons on the Operating Room Environment and the American Institute of Architects Committee on Architecture for Health. In veterinary medicine, no specific guidelines exist, so common sense and translations from human surgery are used. Several solutions are commonly proposed to reduce equipment crowding and cables or lines crossing the floor in the OR [54–56].
Preparation for Open Surgery
All instrumentation for open surgery should be available in case conversion becomes necessary. The entire surgical team should be prepared for a smooth and expedient transition [9,57–64].
Considerations for a Minimally Invasive Theater or Suite
With the advent of minimally invasive, image‐guided laparoscopic procedures and other enhanced visualization and guidance systems, PACS and electronic medical records, the demands and needs for different qualities, types and intensities of light, as well as variations of brightness and focus in the different zones around the room have become primary functional and design challenges and concerns. Lighting systems today must provide flexibility in terms of intensity in the level and movement of light in the space, so that the system can adapt to the different requirements of open surgery, MIS, or image‐guided procedures. The need for different lighting in different zones within the OR to support the specialized functions during the procedure, and the complexity of the integrated OR control systems has added an additional level of complexity beyond what was seen even in the recent past.
The room must accommodate at least two equipment towers (endoscopy and anesthesia), and space must allow for their free movement to either end of the surgical table. Also, adequate clearance from the patient is required to avoid breaks in sterile technique. Ideally, two to three monitors are positioned either on booms, the equipment towers, or separate wheeled carts [55–58].
Figure 3.13 (A). State‐of‐the‐art integrated operating room with simultaneous multiimaging systems for veterinary image‐guided procedures – pictured ceiling rack mounted fluoroscopy and endoscopy systems. (B). The integrated OR single‐post control station near the border of the sterile area, which allows a single
