A Guide as to what are things one needs to know and consider when acquiring Operation Table

WHAT IS AN OPERATING TABLE?

AN OPERATION TABLE is a table on which a patient is laid, and surgical operation carried out. An Operation Table is also known as “Operating Table”, “Surgical table”, “O.T.Table”, “Operation Room Table” ,and ”Operation Theatre Table”.

WHY AN OPERATION TABLE?

A Surgical Operation, particularly speciality procedures, require operation table to have many features, specification and accessories for successful conduct of surgical operation, which is often life saving procedures. Therefore, in order to meet these features, specification and accessories requirement of various surgical procedures, Operation Tables are designed, developed, manufactured and serviced. To mention some of usual features, among others, that are sought by doctors when acquiring a Operation Table are the Load Bearing Capacity, the requirement of Sliding feature for Table Top, a table top that suits manoeuvrability of various surgical positioning, requirement of Radio-Lucent top for X-ray, specific Quality of the material used in construction (non-rusting), the Redundancy or fail-safe features, Various Safety features, Smoothness of operation, Cleaning features and After-Sales Services.

Some of the specifications relates to the motive power used for positioning the table are Hydraulic, Electric, Electro-Mechanical or Electro-Hydraulic to suit customer specific requirement, the minimum and maximum height requirement, various tilt positions both lateral and linear, and the dimensional requirement.

Some of the accessories that are required are the standard accessories such as the mattress, side-railing, side railing clamps, body-horns, shoulder supports, hand-extension table, and Lithotomy rods. There are also specialized accessories such Orthopaedic Extension Devices, Neurological Attachments, among many other accessories required in respective specialities.

WHAT ARE THE TYPES OF SURGERIES OR OPERATIONS THAT ARE CARRIED OUT ON OPERATION TABLES?

Operating tables are used in various types of procedures such as cardiothoracic, cardio-vascular, orthopaedic, neurological, gynaecological, gastric, renal, bariatric, paediatric, robotic, urologic, among other general surgeries.

WHAT ARE THE TYPES OF OPERATION TABLES THAT ARE AVAILABLE IN MARKET?

There are many ways in which Operation Tables may be classified depending on the very purpose of classification.

In terms of the motive power used in manoeuvring the positions of operation tables, it could be broadly classified as Hydraulic, Electrical ( DC motors driven actuators are used for obtaining all required positions), Electro-Mechanical ( a combination of electric power for height adjustments and mechanical crank used for various table top positioning),and Electro-Hydraulic (which uses electric power and hydraulic actuators for redundancy in case of power failure).

In terms of procedure carried out, or in terms of features, specification and accessories, the operation tables may be broadly classified as orthopaedic tables, neurological tables, universal (general operation table), endoscopy table, cardiac table, and bariatric table.

There is yet another type of operation tables used in radiology for various radiological procedures, which are not discussed here since these tables are generally supplied by the radiological equipment manufactures as an accessory to the equipment.

WHAT ARE THE COMMON SURGICAL POSITIONS THAT ARE USED ON AN OPERATION TABLE?

Surgical procedures require proper patient positioning to keep the patient comfortable and safe during surgery, and to provide the surgeon with easy, unobstructed access to the surgical site. Many factors influence the decision of how to position a patient during a procedure:

• The patient's overall condition
• Length of procedure
• Techniques to be used during procedure
• Required exposure at operative site
• Expected anatomical and physiological changes associated with anaesthesia

Furthermore, there are various risk factors that may lead to a patient's vulnerability to injury from improper positioning, such as:

• Long procedures (3+ hours)
• Bone and joint conditions
• Skin breakdown due to aging
• Malnutrition, hypovolemia, anaemia, paralysis, obesity, extreme thinness, or diabetes

The most common surgical positions are Supine, Trendelenburg, reverse Trendelenburg, Prone, Lithotomy, Sitting and Lateral Positions.

SUPINE POSITION

This position is the natural position of the body at rest, making it the most common posture for surgery. Common complications associated with the supine positon are backaches and pressure-point reactions.

TRENDELENBURG POSITION

The Trendelenburg position is a variation of the supine position. The upper torso is lowered and the feet raised, allowing for optimal visualization of the pelvic organs during laparoscopy and lower abdominal procedures.

REVERSE TRENDELENBURG POSITION

Commonly known as the head-up and feet-down position, the reverse Trendelenburg is often used in head and neck procedures.

PRONE POSITION

In this position, the patient lies flat on their stomach and their head is turned to the side. This position is most commonly used for cervical spine, back, and rectal area procedures.

LITHOTOMY POSITION

While in the lithotomy positon, the patient is in supine position and their legs are raised and abducted. Stirrups are needed for this position.

SITTING POSITION

Also known as Fowler's position, the patient in this position is sitting at a 90 degree angle. The knees are slightly flexed and the feet are placed against a padded foot board. This position is ideal for neurosurgery, facial operations, and some shoulder surgeries.

LATERAL POSITION

The lateral position places the patient on the non-operative side so that surgery can be performed on the hip, chest or kidney.

WHICH IS THE BEST OPERATION TABLE?

This is a very relative question to answer. It depends on many factors to define the best table. To be on the safer side, it can be safely assumed that there is not a single table that may be defined as the best operation table since it is relative to the person, application, context etc. However, there is a general belief that imported operation tables, that are manufactured by world’s leading brands, who could be the pioneers in the product segment, who might have invested substantially into developing product based on R&D, invest lot money into meeting highest level of standards such as US FDA, IEC/EU norms in terms of it safety standards, material quality, manufacturing standards, features, specification and accessories are able to offer better products as compared to products that are available in India.

Even in imported operation table, there are many tables that could be classified as mid-segment operation table and high-end operation table which enjoy significant premium in the market and comes at substantial investment many times over the Indian products. Therefore, it is safe to assume that the best brands are mostly able to offer relatively better tables as compared to Indian Products, but at a very high cost.

However, when it comes to operation tables that are manufactured in India, we have substantial improvements in quality, there are products with relatively good quality that are able to deliver when it come to meeting various parameters and functionality, particularly in Indian contexts. We need to consider the economic conditions of patients, the viability of acquiring high cost products. High-end hospitals where they have affordability, they may choose to acquire imported products. However, relatively smaller and mid-segment hospitals where affordability is less could certainly opt for operation tables that are manufactured in India who have a relatively better products and arrangement for after-sales services. There are thousands of operation tables manufactured in India are in operation all across the country and some of them are used in neighbouring and third world countries.

Therefore, the decision as to best table lies in its specific context and a suitable decision may be taken in the matter in the light of above information.

WHAT ARE THE OTHER FACTORS THAT NEED TO BE CONSIDERED WHEN BUYING OPERATION TABLE?

• Try to ascertain whether the table is being offered by a manufacturer or dealer? If a operation table is bought from manufacturer, it is quite possible that you get it at relatively less cost, consider the manufacturer has existing installations, ascertain his arrangement for providing after-sales services which could be decisive in acquiring a proper operation table as a package of product and services.
• Try to meticulously study all the aspect about the table, involve the actual users for proper selection, adequately study the product for comparative assessment in terms of quality, features, specification, accessories, and after-sales services.