Advances in healthcare are being made at an awesome rate. Ideas are turning into reality nearly every day. A hospital’s design must keep up with changing technology as well as the attitudes of staff and patients. One such concern is the design of operating rooms and associated space as Minimally Invasive Surgery (MIS) becomes prevalent in today’s surgical environment. With an aging population demanding faster and cleaner surgeries and recoveries, hospitals must consider how to implement a Minimally Invasive Surgery Plan. This includes training new and current staff to operate new machines in new environments as well as researching how it will affect existing buildings and new construction at hospitals. Determining where to begin can be overwhelming, but there are some major points to consider when renovating or building a Minimally Invasive Surgery Center.
What Is Minimally Invasive Surgery?
Minimally Invasive Surgery can best be defined as surgery performed through small incisions or existing openings in the body with the aid of computers, ultrasounds, robotics, and/or endoscopic tools such as cameras. The result is far less traumatic to the body, provides a faster recovery and has a lower financial cost to the patient. As the United States’ population ages, these results have become infinitely important to the average consumer. Patients want to return to active lifestyles and/or occupations, and are demanding from hospitals and other care providers that they can do so rapidly.
As consumers and doctors demand MIS more and more, healthcare facilities must keep up or risk losing valuable patients and staff to facilities that are implementing the MIS programs. Medical schools, major tertiary hospitals, and training centers are already raising funds, installing equipment, and training staff to satisfy these needs.
What to Consider When Planning a New Minimally Invasive Surgical Suite
Many hospitals are beginning new construction to implement MIS. There are many things to consider when planning new MIS suites. First is the operating room size. The average size of a traditional operating suite is 400 s.f. In MIS-compatible rooms, a room needs to be 650 to 700 s.f. to accommodate additional equipment and staff. Such equipment includes touch screens or voice-activated systems for light and sound control and computer-assisted surgery equipment such as robots used to perform the actual surgery while a surgeon types in commands. When considering which equipment to install into an operating room, it is important to realize that different manufacturers’ products do not always work together. Using a single manufacturer for all equipment makes training, service, and usage much easier and can provide higher quality results.
Mechanical Systems Considerations
Another factor to consider for new MIS suites is the mechanical systems that are needed. At the beginning of surgery, temperatures must be kept low and then brought up rapidly towards the end of surgery. Traditional operating rooms require temperatures from a low of about 68 degrees to a high of about 80 degrees Fahrenheit. Because MIS machinery operates at a higher temperature and must not overheat, MIS operating rooms must have temperatures from as low as 55 degrees. The machinery must not overheat because steam and humidity can form, causing the machinery to malfunction. Mechanical engineers are working with these challenges by using new control sequences and direct digital controls for the temperature and humidity. Because many hospitals desire MRI and Gamma Knife machines inside the operating rooms for ease of use, mechanical engineers must also develop ways to incorporate Radio Frequency and Radiation Shielding into the operating room. Non-ferrous (non-magnetic) metal must be used in this shielding, as in all instruments used in the room with MRIs and Gamma Knifes. With traditional machinery and surgical instruments made of magnetic materials, this presents a significant challenge to mechanical engineers. Still another factor to consider is how to pump any gases needed in and out in the operating room. Engineers have developed a new system by mounting a small boom from the ceiling that can pump in oxygen, nitrogen oxide, and carbon dioxide and pump out any harmful gases. The boom can be positioned anywhere around the patient. These booms provide a major improvement over the traditional plug-in gas induction and gas evacuation systems that could only serve a portion of the room.
Electrical Systems Requirements
The increased use of scopes, computer monitors, and other minimally invasive equipment has placed higher demands on the electrical systems in the operating suite. For example, the use of CRT screens has drastically changed the requirements of lighting systems. The lighting system must provide adequate light for surgical tasks, but must be adjustable to allow staff to view images on CRT screens without glare or other interference. Another factor when planning MIS-compatible electrical systems is the power supply. Most of the equipment used for monitoring the patient, as well as the life support equipment, is controlled by microprocessor- and computer-based controllers. This has made the need for clean, reliable, and distortion-free service imperative. The power for this equipment must be separate from the utility delivery system so that disruptions will not affect the surgical procedure. The capability to generate electrical power independent of the local electric utility service is a necessity today, not only to insure continued use of the operating suite but to also allow support services to function. Power demands will increase as MIS becomes more prevalent in operating suites of the future and will necessitate designing spare capacity in the system to meet this demand.
Other Considerations
When planning to retrofit an existing operating suite for MIS, it is important to consider additional factors. Finishes must be selected carefully, as paint must have anti-microbial qualities and plastics must withstand rapid temperature changes. Hospitals should also consider incorporating natural light sources into the operating room. In the event of a power outage, it can take up to 10 seconds for backup lights to come on. Not only do windows with natural light filtering through provide additional light for emergency situations, but also studies have shown that natural light can reduce stress in surgical staff working in the operating room. Infection control is also a major concern for the retrofit of an existing operating suite. During construction, barriers must be put in place to contain debris and dust in the construction area. Once the retrofit is complete, staff can maximize their contributions to infection control by utilizing the equipment associated with MIS, as it is designed to minimize the amount of contact between the patient and staff.
Cost Impact — New Construction vs. Retrofitting
Cost impact is a major concern when deciding between building a new operating suite and retrofitting an existing one. Many hospitals have found that while the initial cost of a new suite can be sizable, it can actually save a considerable amount of money in the long term. When building a new operating suite, use of the existing suite does not have to be interrupted. Fewer barriers and infection control measures must be in place and staff can be more productive when there is a seamless transition from the existing operating suite to a new one. Healthcare facilities must carefully consider the cost impact of new construction versus renovation and review the options with their architects and engineers.
The Future of Minimally Invasive Surgery
There is no doubt that technology advancements will continue to dominate operating room evolution. Evidence shows that the demand for minimally invasive procedures is likely to escalate, and that the industry can sustain itself and keep up with the demand from doctors, staff and patients. Today minimally invasive procedures are performed at tertiary medical centers, but soon they will likely become part of community medical centers and ambulatory surgery centers, resulting in more and more competition in the healthcare industry. In addition, with computer-assisted procedures taking center stage, staffing requirements in the operating room will decrease.
Healthcare facilities of the future must become adaptable to reduce costs and keep up with ever-advancing technology. While the considerations before commencing construction are numerous, taking steps towards understanding the future of MIS enables hospitals to make the best decisions for their facilities. Facilities must weigh the costs, both monetary and intangible, of retrofitting versus total replacement of an operating suite. Alternate delivery strategies, including design-build, are critical elements in this process. Feasibility studies prior to implementation are crucial to the success of any proposed project and all stakeholders must be involved in the planning process to optimize the success of the project. With demand for minimally invasive surgery increasing on a daily basis, facilities must look to the future and recognize its impact on the healthcare industry today and in the future.
Valentine A. Satko, AIA, is a Principal Architect at GMK Associates, Inc., in Columbia, SC. He has master-planned over 25 hospitals during his career. Mr. Satko develops space program requirements, alternative conceptual solutions, and conducts frequent interface meetings with user groups, physicians, and governance in order to achieve facility solutions compatible with institutional objectives. He may be reached at (803) 256-0000.