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An operating theater (also known as an operating room (OR), operating suite, or operation suite) is a facility within a
hospital A hospital is a health care institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...
where surgical operations are carried out in an
aseptic Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
environment. Historically, the term "operating theater" referred to a non-sterile, tiered
theater Theatre or theater is a collaborative form of performing art that uses live performers, usually actors or actresses, to present the experience of a real or imagined event before a live audience in a specific place, often a stage. The perform ...
or
amphitheater An amphitheatre (British English) or amphitheater (American English; both ) is an open-air venue used for entertainment, performances, and sports. The term derives from the ancient Greek ('), from ('), meaning "on both sides" or "around" and ...
in which students and other spectators could watch surgeons perform surgery. Contemporary operating rooms are usually devoid of a theater setting, making the term "operating theater" a misnomer in those cases.


Operating rooms

Operating rooms are spacious, in a
cleanroom A cleanroom or clean room is an engineered space, which maintains a very low concentration of airborne particulates. It is well isolated, well-controlled from contamination, and actively cleansed. Such rooms are commonly needed for scientif ...
, and well-lit, typically with overhead surgical lights, and may have viewing screens and monitors. Operating rooms are generally windowless, though windows are becoming more prevalent in newly built theaters to provide clinical teams with natural light, 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 An operating table, sometimes called operating room table Table may refer to: * Table (furniture), a piece of furniture with a flat surface and one or more legs * Table (landform), a flat area of land * Table (information), a data arrangemen ...
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, or sometimes integrated within, is a dedicated scrubbing area that is used by
surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training a ...
s, 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. Operating rooms are typically supported by an anaesthetic room, prep room, scrub and a dirty utility room. 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, 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. Temperature and surgical site infections (SSI). The current operating room design temperature is between . Operating rooms are typically kept below 73.4 °F (23 °C) & room temperature is the most critical factor in influencing heat loss. Surgeons wear multiple layers (surgical gowns, lead aprons) and may perspire into an incision if not kept cool; excessive heat may also decrease concentration and increase the frequency of errors. Higher temperatures increased subjective physical demand and frustration of the surgical staff. One option is to heat the patient to prevent surgical site infections (SSI) and keep the surgical team cool. There is a 3 fold increase in infection for every 1.9 degree Celsius body temperature decrease because of weakened immune response at lower body temperatures. Radiation is the major cause of heat loss in patients, and convection (through air) is the second cause of heat loss. In the first hour, it is common for a healthy patient’s temperature to decrease 0.5-1.5 °C as anesthesia causes rapid decrease in core temperature. One study found that the most efficient method of maintaining normothermia included using warm wraps and a heating blanket (commercially known as a Bair Hugger) Additionally, pre-warming for thirty minutes may prevent hypothermia.


Operating room equipment

*The operating table in the center of the room can be raised, lowered, and tilted in any direction. *The operating room lights are over the table to provide bright light, without shadows, during surgery. *The
anesthesia machine An anaesthetic machine (British English) or anesthesia machine (American English) is a medical device used to generate and mix a fresh gas flow of medical gases and inhalational anaesthetic agents for the purpose of inducing and maintaining ana ...
is at the head of the operating table. This machine has tubes that connect to the patient to assist them in breathing during surgery, and built-in monitors that help control the mixture of gases in the breathing circuit. *The anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and other supplies that the anesthesiologist may need. *Sterile instruments to be used during surgery are arranged on a stainless steel table. *An electronic monitor (which records the heart rate and respiratory rate by adhesive patches that are placed on the patient's chest). *The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures the amount of oxygen contained in the blood. *Automated blood pressure measuring machine that automatically inflates the blood pressure cuff on a patient's arm. *An electrocautery machine uses high frequency electrical signals to cauterize or seal off blood vessels and may also be used to cut through tissue with a minimal amount of bleeding. *If surgery requires, a
heart-lung machine Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...
or other specialized equipment may be brought into the room. *Advances in technology now support hybrid operating rooms, which integrate diagnostic imaging systems such as
MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...
and
cardiac catheterization Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is coronary catheterization th ...
into the operating room to assist surgeons in specialized neurological and cardiac procedures.


Surgeon and assistants' equipment

People in the operating room wear PPE (personal protective equipment) to help prevent bacteria from infecting the surgical incision. This PPE includes the following: *A protective cap covering their hair *Masks over their lower face, covering their mouths and noses with minimal gaps to prevent inhalation of plume or airborne microbes *Shades or glasses over their eyes, including specialized colored glasses for use with different lasers. a fiber-optic headlight may be attached for greater visibility *Sterile gloves; usually latex-free due to latex sensitivity which affects some health care workers and patients *Long gowns, with the bottom of the gown no closer than six inches to the ground. *Protective covers on their shoes *If x-rays are expected to be used, lead aprons/neck covers are used to prevent overexposure to radiation 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.


History

Early operating theaters in an educational setting had raised tables or chairs at the center for performing operations surrounded by steep tiers of standing stalls for students and other spectators to observe the case in progress. The surgeons wore street clothes with an
apron An apron is a garment that is worn over other clothing to cover the front of the body. The word comes from old French ''napron'' meaning a small piece of cloth, however over time "a napron" became "an apron", through a linguistics process cal ...
to protect them from blood stains, and they operated bare-handed with unsterilized instruments and supplies. The
University of Padua The University of Padua ( it, Università degli Studi di Padova, UNIPD) is an Italian university located in the city of Padua, region of Veneto, northern Italy. The University of Padua was founded in 1222 by a group of students and teachers from ...
began teaching medicine in 1222. It played a leading role in the identification and treatment of diseases and ailments, specializing in autopsies and the inner workings of the body. In 1884 German surgeon Gustav Neuber implemented a comprehensive set of restrictions to ensure sterilization and
aseptic Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented
autoclave An autoclave is a machine used to carry out industrial and scientific processes requiring elevated temperature and pressure in relation to ambient pressure and/or temperature. Autoclaves are used before surgical procedures to perform steriliza ...
. 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 Mercury(II) chloride (or mercury bichloride, mercury dichloride), historically also known as sulema or corrosive sublimate, is the inorganic chemical compound of mercury and chlorine with the formula HgCl2. It is white crystalline solid and is ...
, 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. In 1890 surgical gloves were introduced to the practice of medicine by William Halsted. Aseptic surgery was pioneered in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territo ...
by Charles McBurney.


Surviving operating theaters

The oldest surviving operating theater is thought to be the 1804 operating theater of the
Pennsylvania Hospital Pennsylvania Hospital is a private, non-profit, 515-bed teaching hospital located in Center City Philadelphia and is part of the University of Pennsylvania Health System. Founded on May 11, 1751, by Benjamin Franklin and Dr. Thomas Bond, Penn ...
in Philadelphia. The 1821
Ether Dome The Ether Dome is a surgical operating amphitheater in the Bulfinch Building at Massachusetts General Hospital in Boston. It served as the hospital's operating room from its opening in 1821 until 1867. It was the site of the first public demonstra ...
of the
Massachusetts General Hospital Massachusetts General Hospital (Mass General or MGH) is the original and largest teaching hospital of Harvard Medical School located in the West End neighborhood of Boston, Massachusetts. It is the third oldest general hospital in the United Sta ...
is still in use as a lecture hall. Another surviving operating theater is the Old Operating Theatre in
London London is the capital and List of urban areas in the United Kingdom, largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary dow ...
. Built in 1822, it is now a museum of surgical history. The Anatomical Theater at the
University of Padua The University of Padua ( it, Università degli Studi di Padova, UNIPD) is an Italian university located in the city of Padua, region of Veneto, northern Italy. The University of Padua was founded in 1222 by a group of students and teachers from ...
, in
Italy Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical ...
, inside Palazzo Bo was constructed and used as a lecture hall for medical students who observed the dissection of corpses, not surgical operations. It was commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in 1595.


See also

*
Anatomical theater An anatomical theatre (Latin: ) was a specialised building or room, resembling a theatre, used in teaching anatomy at early modern universities. They were typically constructed with a tiered structure surrounding a central table, allowing a lar ...
*
Hybrid operating room A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, X-ray computed tomography (CT) scanners or magnetic resonance imaging (MRI) scanners. These imaging devices enable minima ...


References


External links


Video of a newly-built orthopaedic operating theater in the United Kingdom
{{Authority control Surgery Hospitals