Operating theater

Inside a contemporary operating room

An operating theater, also known as an operating theatre, operating room (OR) or operating suite, is a facility within a hospital where surgical operations are carried out in a sterile environment. Historically, the term "operating theatre" referred to a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery.

History

The Agnew Clinic, 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation.
An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator

Operating theatres had a raised table or chair of some sort at the center for performing operations, and were surrounded by several rows of seats (operating theatres could be cramped or spacious) so students and other spectators could observe the case in progress. The surgeons wore street clothes with an apron to protect them from blood stains, and they operated bare-handed with unsterilized instruments and supplies (gut and silk sutures were sold as open strands with reusable, hand-threaded needles; packing gauze was made of sweepings from the floors of cotton mills). In contrast to today's concept of surgery as a profession that emphasizes cleanliness and conscientiousness, at the beginning of the 20th century the mark of a busy and successful surgeon was the profusion of blood and fluids on his clothes.

In 1884 German surgeon Gustav Neuber implemented a comprehensive set of restrictions to ensure sterilization and aseptic operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented autoclave.[1] In 1885 he designed and built a private hospital in the woods where the walls, floors and hands, arms and faces of staff were washed with mercuric chloride, instruments were made with flat surfaces and the shelving was easy-to-clean glass. Neuber also introduced separate operating theaters for infected and uninfected patients and the use of heated and filtered air in the theater to eliminate germs.[2] In 1890 surgical gloves were introduced to the practice of medicine by William Halsted.[3] Aseptic surgery was pioneered in the United States by Charles McBurney.[4]

Operating rooms

Contemporary operating rooms are devoid of a theater setting (though some in teaching hospitals may have small galleries), making the term "operating theater" a misnomer for the modern facility. Operating rooms are spacious, easy to clean, and well-lit, typically with overhead surgical lights, and may have viewing screens and monitors. Operating rooms are generally windowless and feature controlled temperature and humidity. Special air handlers filter the air and maintain a slightly elevated pressure. Electricity support has backup systems in case of a black-out. Rooms are supplied with wall suction, oxygen, and possibly other, anesthetic gases. Key equipment consists of the operating table and the anesthesia cart. In addition, there are tables to set up instruments. There is storage space for common surgical supplies. There are containers for disposables. Outside the operating room is a dedicated scrubbing area that is used by surgeons, anesthetists, ODPs (operating department practitioners), and nurses prior to surgery. An operating room will have a map to enable the terminal cleaner to realign the operating table and equipment to the desired layout during cleaning.

Several operating rooms are part of the operating suite that forms a distinct section within a health-care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel to change, wash, and rest, preparation and recovery rooms(s), storage and cleaning facilities, offices, dedicated corridors, and possibly other supportive units. In larger facilities, the operating suite is climate- and air-controlled, and separated from other departments so that only authorized personnel have access.

Operating room equipment

Hybrid operating room for cardiovascular surgery at Gemelli Hospital in Rome

Surgeon and assistants equipment

People in the operating room wear PPE (personal protective equipment) to help prevent germs from infecting the surgical incision. This PPE includes the following:

The surgeon may also wear special glasses that help him/her to see more clearly. The circulating nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile team. They must keep a distance of 12-16 inches from any sterile object, person, or field.

Surviving operating theaters

Old Operating Theatre in London

While operating theaters are no longer used for surgery, some still exist. One of the oldest surviving operating theaters is the Old Operating Theatre in London. Built in 1822, it is now a museum of surgical history. Another theater still exists at the University of Padua, in Italy, inside Palazzo Bo. It was commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in 1594. Another famous operating theater is the Ether Dome in Boston. Built in 1824, it is now a conference room and tourist attraction. Pennsylvania Hospital in Philadelphia also boasts its own surviving operating theater, built in 1804.[5]

In popular culture

See also

References

  1. ↑ Deysine, M (2003). Hernia infections: pathophysiology, diagnosis, treatment, prevention. Informa Health Care. pp. 13. ISBN 0-8247-4612-0.
  2. ↑ Bishop, WJ (1995). The Early history of surgery. Barnes & Noble. pp. 169. ISBN 1-56619-798-8.
  3. ↑ Porter, R (2001). The Cambridge illustrated history of medicine. Cambridge University Press. pp. 376. ISBN 0-521-00252-4.
  4. ↑ Gross, E (1990). This day in American history. Verlag für die Deutsche Wirtschaft. pp. 61. ISBN 1-55570-046-2.
  5. ↑ http://www.uphs.upenn.edu/paharc/tour/tour5.html
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