Operating Theatres of the Future

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Operating Theatres of the Future was the title of an Architects for Health Event that took place at The RIBA, 66 Portland Place, London, on Thursday 31 May 2007

Chairman: Mike Sury, FRCA – Consultant Paediatric Anaesthetist, Great Ormond Street Hospital London, Honorary Senior Lecturer Portex Unit Institute of Child Health. Email: surym@gosh.nhs.uk


“The Future of Surgery” – Professor Erik Fosse, professor and director of the Interventional Centre of Rehabilitation of the University Hospital of Oslo, Norway. Erik Fosse is specialised in general surgery and cardiothoracic surgery. He is professor and director of the Interventional Centre which is a research and development department at Rikshospitalet University hospital in Oslo. The department develops new treatment strategies based on advanced imaging technology and work closely with industry to develop and validate new technological solutions for surgical intervention and patient monitoring. http://www.ivs.no

“Surgical Work Places” – Andrew Walters of Maquet – Surgical Workplaces. Andrew is the Product Manager of Modular Theatre Systems of Maquet and will be talking on the Modular OR-System VARIOP, and the benefits that the company’s approach offers to surgical workplaces. http://www.maquet.com

” A recent case Study: The Barn Theatre at the Royal Liverpool and Broadgreen University Hospitals” – John Knape, Northern Regional Director of Nightingale Associates. John has throughout his career specialised in the design of healthcare facilities. He led Nightingale Associates’ team responsible for the design of the recently completed £70m Broadgreen Hospital Development, delivered through ‘ProCure 21’, which includes an innovative ‘Barn’ Operating Theatre. John will be talking about the reasons why he adopted the ‘Barn’ theatre solution and the perceived advantages from a surgical perspective (prior to occupation) before talking about the construction. http://www.nightingaleassociates.com


Donal O’Donoghue, Divisional Director for Medical Surgery at The Royal Liverpool and Broadgreen University Hospitals, NHS Trust
John Davidson, John Davidson is a consultant Orthopaedic surgeon and Clinical Director of the Royal Liverpool and Broadgreen University Hospitals NHS Trust. John specialises in Joint replacement, specifically in knees and hips. He sits on International Advisory Boards for developing new technologies in surgery and is a frequent faculty member at international meetings on surgical technique and practice.
Donal and John will talk about how the ‘Barn’ theatre concept was considered and taken up by their team and the ‘Barn’ theatre in use – how it operates (i.e. the patient journey), whether it has met the surgeon’s expectations, infection rates, effects on staff morale, good/bad features and what they would want to have done differently if doing the scheme again. http://www.rlbuht.nhs.uk

Sponsor MAQUET

Report on the AfH The Operating Theatres of the Future Event by Peter Scher:

It was a stroke of brilliance by Architects for Health to hold this meeting only two weeks after the absorbing and uplifting meeting on Hospices. This one was quite as absorbing but hardly uplifting.

Professor Erik Fosse, Director of the Interventional Research Centre at Oslo’s Rijkshospitalet, presented a thorough and penetrating review of recent innovations in medical technology. This will furnish our professional discourse with an impressively advanced vocabulary – mulitmodal image guidance, telemanipulators, focused ultrasound, ‘Pathfinder’ robots and so on.

The purposes of the Interventional Research Centre are to develop new procedures and treatment strategies, to compare them with existing ones and to study the social and economic consequences. Non-invasive procedures and ‘Keyhole’ techniques are increasingly replacing conventional surgery. Day surgery and early discharge require patient follow-up to move to primary care.

Professor Fosse described the transformations already evident in surgery in terms of a change from a handicraft to an industrial culture. “You become what you do,” he said: cardiologists become cardiac surgeons, radiologists perform more complex procedures, surgeons become computerised and engineers, mathematicians and physicists enter the theatre now. Under seven headings Professor Fosse tabulated the differences between the handicraft and industrial cultures –
“ownership” – from individual to corporate
“product development” – from integrated to separated
“knowledge transfer – from personal to explicit
“collaboration” – from interdisciplinary to cross-disciplinary
“review” – from individual to evidence-based
“value” – from procedure to product-based
“treatment” – from tailor-made to standardised.

In considering surgery (or intervention as we must now call it) in isolation from health care, and for those who see “healthcare” as an “industry” delivering a “product” this analogy has some relevance. In answer to a question from Ann Noble, Chair of Architects for Health, Professor Fosse said that the handicraft tradition in which ownership, knowledge transfer, review, value and treatment were controlled by the expert consultant clinician and his/her team has become too expensive. “Hospitals are being run as corporations” and “it is only a matter of time before corporations take over medical education”.

The meeting was expertly chaired by Michael Sury, Consultant Paediatric Anaesthetist at Great Ormond Street. He asked about the barriers to change and Professor Fosse said they were “resources, which are very expensive” and the “challenge to existing human power structures”.

“Toys for the boys” are indeed very, very expensive but individual human care for sick, anxious and fearful patients is priceless. It never came up at this meeting while it had been the central theme of Hospices.

The well-attended meeting was generously sponsored by Maquet and Andrew Walters their Product Manager gave a clear and informative presentation of the Modular Operating Room System, VARIOP. John Knape of Nightingale Associates and John Davidson and Donal O’Donoghue, Clinicians of the Royal Liverpool and Broadgreen University NHS Trust, completed the session describing the well-known ‘Barn’ theatre there.

Peter Scher
June 2007


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