Surgery: Operating Rooms In the Round

As surgery on the body’s most vital organs, the brain and heart, has become more daring and more effective, it has also become more complex. Each new mechanical or electronic aid to the surgeon’s skills requires people to run it, and an operating room being used for open-heart surgery now looks like a mob scene from Shakespeare. The crowding and confusion not only bother the surgeon; they are also a disadvantage for the patient: every extra warm body in the operating room is a potential source of infection. Last week, at the huge Clinical Center in Bethesda, Md., the National Institutes of Health dedicated an ultramodern surgical wing designed to clear the crowds from the operating room, while giving both surgeons and patients the greatest possible benefits from advances in technology.

From the air, the $2,000,000 operating wing looks like a giant tadpole, an chored to the main building by its tail.

Earthbound doctors, noting its blue glass panels, have dubbed it “the cyanotic silo.” Arranged in a basically circular pattern (see diagram), the ground floor is used for a blood bank. The second floor is for heart surgery, but the actual operating rooms occupy only two spaces shaped like generous slices of a pie. The third floor has masses of equipment for recording the research doctors’ data, and glass observation domes for looking down into the heart operating rooms.

The fourth floor, for brain surgery, is much like the second, but with some added equipment that only the neurosurgeon needs, such as a stereotactic device for placing electrodes at precise points deep inside the skull.

“This wing,” says the Clinical Center’s Director Jack Masur, “will give our surgical investigators a new resource. It will give them information that they only guessed at before, or got only spasmodically—such things as systolic, diastolic and also venous blood pressure, blood temperature as well as body temperature, blood loss since the operation began.” All the cables from the monitoring equipment that supplies such information are plugged into a junction box mounted in a pedestal at one end of the operating table.*From there, a cable in the floor carries the information to the central recording rooms that Assistant Director Robert Farrier calls “the central nervous system of the operating wing.”

Mumbling Masks. In older operating rooms, Dr. Masur notes, the surgeon had to rely on an assistant, or the anesthesiologist or a nurse, to mumble bits of information to him through a muffling mask. “Now he just glances up to an illuminated display board mounted high on the wall that continually flashes the physiological data from the recording room. The data are also stored, and doctors can study them later to see what went on from beginning to end, and therefore give better care to the next patient.”

Even though they are miniaturized, the recording rooms’ electronic instruments that give the surgeons so much information fill huge, stainless steel consoles studded with a bewildering array of knobs, screens and lights. Signals from the consoles go not only to the display boards in the operating room, but to similar panels in observation rooms for visiting surgeons, and to the consoles at which technicians sit, behind glass panels, only a few feet from the operating table. The console technicians are in telephone communication with the operating team, and they make many adjustments of equipment that used to clutter the operating room itself.

24 Channels. Each 3-ft. by 4-ft. display board consists of an oscilloscope and a panel on which the information from the scope’s wave forms can be read numerically. The surgeon can select as many as eight of 24 different channels for this “readout board,” and he can switch channels whenever he wants to. He can even get the technicians to play back a previous part of the record for comparison with current wave forms.

“We have been able to reduce the number of people in the heart room to a hard core of seven,” says Dr. Farrier. “Three surgeons, an anesthesiologist, the instrument nurse who handles only sterile materials, a circulating nurse for the rest, and a technician. Since surgery involves teaching, we put in a good color TV monitor over the operating table, and keep the surgical observers out of the room.”

Plugged In & Out. The heart patient is taken to the second floor on a wheeled operating table, already hooked up to all the electrical leads for all the monitoring devices that will help him through the operation. In the anesthesia room, the electrical leads are plugged into a pedestal connected with the recording room, and the anesthesiologist (a physician) gives the chosen mixture of oxygen and anesthetic gases. Then patient and table are wheeled into the operating room, and the monitoring equipment leads are plugged into another pedestal there.

Above the heart surgery table and its brilliant lights, a cylinder 15 ft. wide pours out a flow of sterile air, at 6,000 cu. ft. a minute, adjusted to the most desirable temperature and humidity. The air is drawn off near the floor and is not recirculated. So efficient is this system that not more than one microbe or grain of pollen gets through in every hundred cubic feet of air.

Even before last week’s dedication staff members had tried out the new rooms. Said NIH Director James Shannon: “This setup will be out of date tomorrow, but it’s the ultimate in what’s available today.”

*At the head for heart operations, but at the foot for head operations, so that the gear will not be in the brain surgeon’s way.