Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation, or ECMO for short, is an advanced therapy that is sometimes used to treat people with life-threatening heart and lung failure, to do the work of the heart and lungs when a patient’s own organs are too sick or weak to work on their own. It is effectively a modified heart-lung bypass machine—a machine that takes over heart and lung function (meaning it adds oxygen to and removes carbon dioxide from a patient’s blood supply). 

 But unlike a heart-lung bypass machine, which is designed for short-term use (during heart surgery, for instance), ECMO machines provide long-term heart and lung support over a period of hours, days, or even weeks to give a patient’s heart and lungs time to heal and regain function. It provides a kind of bridge, a temporarily replacement that keeps the functions of the heart and lungs going while doctors treat the underlying problem.

ECMO can be used for patients of all ages, from infants to adults. It can help patients with a range of severe heart and lung conditions, from cardiac arrest to respiratory failure. But in most cases, ECMO therapy is used only when all other conventional treatments have failed to resolve the underlying heart or lung disorders.  

ECMO Machine

The complete ECMO Machine 

 

 

 

 

 

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Connecting To ECMO

Connecting a patient to the ECMO machine requires surgery. The ECMO machine connects to a patient through plastic tubes called cannulas. After giving the patient an anticoagulant, a medication that prevents blood from clotting, the doctor inserts cannulas into large arteries and veins located in the chest, neck, or legs. Once connected, the ECMO machine draws blood from the patient, which it then passes through the cannulas and into an artificial lung that infuses the blood with oxygen and removes carbon dioxide. The ECMO machine then warms this treated blood to body temperature and pumps it back into the patient. In cases where a patient’s heart cannot circulate blood on its own, a mechanical pump takes over the heart’s role and pumps blood through the patient’s circulatory system.

ECMO therapy is frequently a treatment of last resort. It is recommended when other treatments have failed to resolve the underlying problem, but there is still a possibility of recovery. 

The doctors continue to administer sedatives and pain medications after surgery to keep patients as comfortable and pain-free as possible, perform routine chest X-rays, run regular blood tests to assess oxygen and carbon dioxide levels that allow doctors to evaluate and track the patient’s lung and heart health and to check for possible infections.

Basic setting up of the ECMO

Connecting to a patient

Applications

While there is no fixed list of conditions for which ECMO is used, doctors may recommend its use in the following situations:

• Respiratory failure (when the lungs fail to maintain adequate oxygen levels or remove enough carbon dioxide from the blood)
• Heart transplantation
• Lung transplantation
• Cardiac arrest (when the heart fails to pump blood effectively)
• Cardiogenic shock (when the ventricles of the heart do not function properly, resulting in insufficient blood flow)
• Pulmonary embolism (when an artery in the lungs is blocked)
• Birth defects of the heart
• Acute Respiratory Distress Syndrome, ARDS (a type of respiratory failure that prevents adequate oxygen from getting to the lungs and blood)

 

Why Is ECMO used in some COVID-19 Patients?

Some people severely affected by COVID-19 develop a life-threatening lung condition called acute respiratory distress syndrome, or ARDS for short. People with ARDS struggle to get enough oxygen into their lungs and blood due to a buildup of fluid in air sacs called alveoli. Some COVID-19 patients with ARDS who do not respond to conventional treatment may benefit from ECMO therapy. 

In general, doctors aim to take patients off ECMO therapy as quickly as possible. Because it is used for patients with a range of conditions, each with its own recovery timetable, the length of time someone is on ECMO therapy can vary greatly. Some patients need it for only a few hours while others may require days or weeks of ECMO support.

 

Once the patient reaches a point at which the ECMO machine is no longer necessary, the ECMO team will begin the process of weaning in which they steadily decrease the patient’s blood flow through the machine. Over several hours, they track the patient’s response to this reduction in ECMO support. If the patient responds well, and the ECMO team concludes that discontinuation of ECMO is safe, a surgeon will remove the cannulas. 

 

After coming off ECMO, a patient might require a ventilator to provide breathing support. As soon as the patient is able to breathe without assistance, doctors will remove the ventilator. But patients may still need to stay in the hospital for days or weeks, at least until vital signs are stable. Many will also need physical therapy to help regain muscle strength, as well as speech therapy to aid recovery after long-term use of a ventilator’s breathing tube.  

  

                                            Ref: Youtube.com: "I almost died" by CNA

What are the risks associated with ECMO?

ECMO therapy itself comes with its own set of risks including:

• Bleeding: Bleeding affects up to 50% of ECMO patients and, in some cases, can be life-threatening. ECMO therapy requires the use of anticoagulants, medications that thin the blood (and prevent the formation of clots) to keep the blood flowing through the body and ECMO machine. But these medications also increase the likelihood of excess bleeding. As a result, hemorrhaging may occur in a number of places, including the lungs, stomach, mouth, nose, and brain. Doctors watch for signs of bleeding; medication or surgery may be necessary to stop it.
• Kidney Failure: In some cases, patients on ECMO do not circulate enough blood to their kidneys, resulting in kidney failure and the potential need for dialysis, a machine that does some of the work normally done by kidneys. Kidney function usually returns after the patient is removed from the ECMO machine, though sometimes the kidneys do not recover, and the patient will require lifelong dialysis treatment.
• Bacterial Infection: Because cannulas are inserted into veins and arteries in ECMO therapy, bacteria can have direct access to the patient’s blood stream. If unchecked, infections may result, such as bacterial pneumonia. If infection is suspected, patients are treated with a course of antibiotics and cannulas may be replaced.
• Stroke: In rare cases, ECMO patients develop small blood clots that can reduce the flow of blood to the brain. This raises risk for stroke.  
• Pulmonary Embolism: Though it is rare, some patients on ECMO develop a blood clot that blocks blood flow in the lungs. Pulmonary embolism can cause permanent damage to the lungs, as well as damage to other organs as the lungs may be unable to provide enough oxygen to the body.  

         

            Reference: www.yalemedicine.org/conditions/ecmo

Note: Information on this page is provided for interest only on a 'best effort' basis and does not constitute personal advice. Always discuss medical conditions and related mattyers with your doctor(s).

PROTON THERAPY

Proton beam therapy is a type of radiotherapy that uses a beam of high energy protons, which are small parts of atoms, rather than high energy x-rays (called “photons”) to treat specific types of cancer.
Proton beam therapy enables a dose of high energy protons to be precisely targeted at a tumour, reducing the damage to surrounding healthy tissues and vital organs which is an advantage in certain groups of patients or where the cancer is close to a critical part of the body such as the spinal cord.

Proton therapy cancer treatment begins when each proton begins its journey at the injector located within an electric field. In the field, hydrogen atoms then separate into negatively charged electrons and positively charged protons. The protons travel through a vacuum tube within a pre-accelerator. This process boosts their energy to two million electron volts. The protons continue in the vacuum tube and begin their high-speed journey in the synchrotron. They travel around the synchrotron about 10 million times per second. Each time they circulate, a radiofrequency cavity within the ring delivers a boost of energy. This increases the protons' energy to between 70 and 250 million electron volts. The voltage achieved is enough to place them at any depth within the human body.

Fig shows the superconducting Synchrotron and the Proton Beam Transport System

Beam Transport System

 
After leaving the synchrotron, the protons move through a beam transport system, continuing in the vacuum tube through a series of steering and focusing magnets that guide them to the proton treatment rooms. Each proton treatment room has a beam delivery system, or nozzle, is the last device the protons travel through before entering the body. The nozzle shapes and spreads out the proton beam in three dimensions. 

Fig above shows Proton Magnet focus the beam and direct it into each treatment room.

Radiation oncologists must determine location, shape, and tissue density of the target tumor before determining the number of protons to deliver. They must also calculate the depth that the protons must travel in order to calculate the speed and shape of the beam. These decisions render a beam that is highly accurate and practically ‘tailor made’ for a specific treatments.

Treatment Gantry of a Proton Therapy System

After leaving the nozzle, the protons enter the patient's body.

The equipment in the proton therapy treatment rooms vary based on the conditions treated. One proton treatment room may have a stationary beam with two branches – one branch for irradiating eye tumors and the other for central nervous system tumors and tumors of the head and neck. The other treatment rooms may have gantries – wheels that are 35 feet in diameter that revolve around the patient to direct the beam exactly where needed. From the patient's perspective, all that is visible is a revolving, cone-shaped device.

Proton beam therapy is only suitable for certain types of cancer, such as highly complex brain, head and neck cancers and sarcomas as it does not lead to better outcomes for many cancer cases than using high energy x-rays, which is still considered the most appropriate and effective treatment for the majority of cancers.

Like high energy x-ray radiotherapy, proton beam therapy is painless, but patients may experience side effects similar to those experienced from other forms of radiotherapy.

How Does Proton Therapy's Effectiveness Compare to IMRT or Other X-ray Treatments?

Because proton beams can be delivered in higher doses and with far more accuracy, proton therapy typically can control cancer with fewer treatments than IMRT. This pinpoint accuracy also results in fewer long-term side effects (since the radiation does not spill over and damage healthy tissue and organs) meaning that patients treated with proton therapy experience a higher post-treatment quality of life as compared to IMRT and even conventional x-ray treatments.

Is Proton Radiation Therapy Ever Combined?

Yes. Conformal proton therapy is often used in conjunction with X-ray therapy. This method boosts the dose to sites of gross disease and allows irradiation of a large tissue volume. Depending on the amount of cancer within a particular lymph node and type of cancer that is present, a patient may be at risk for harboring microscopic nests of cancer cells within the nodes. These nodes may lie at some distance from the primary tumor and may not be irradiated if conformal proton treatment alone is delivered to the tumor.
The objective of the treatment plan is to treat both the primary tumor and any areas where a microscopic tumor might hide. X-ray treatment alone will limit the total dose of radiation that can be given due to the high doses it delivers to large amounts of healthy tissue. Therefore, conformal proton radiation therapy is used to treat the primary tumor, and is then followed by X-ray therapy to treat the regional nodes. By giving some of the treatment with conformal protons, the total X-ray dose can be reduced substantially.
This reduces the risk of complications and permits treatment of potentially involved lymph nodes. Microscopic cancer within these nodes might be missed if X-rays were not used.

Side-Effect

Since proton therapy allows the radiation to unfold directly in the tumour, the surrounding tissue and organs are protected to the best of their ability. If a reaction – i. e. a side effect – occurs, only the irradiated body region is usually affected. This can lead to irritation of the skin or mucous membranes, which usually recede completely within two to three weeks after treatment. Sometimes, however, a kind of permanent scarring can also occur as a late consequence.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 

Reference: https://protons.com/proton-advantage/how-does-proton-therapy-work

HYBRID OPERATING ROOM

A hybrid operating room is where major procedures that combines a conventional surgical and interventional procedure guided by fluoroscopic or MRI imaging in a hybrid room without interruption.

Traditional fixed C-arms produce 2D fluoroscopy or 3D rotational angiography but with the advanced technology nowadays, C-arms are able to acquire CT-like 3D images and used for image guided surgery and also in intra-operative imaging like flow analysis. With these newer fluoroscopic C-arms where the device image intensifiers are of the digital flat panel detectors has thus enabled the fluoroscopy techniques to transit into three dimensional CT-like imaging capability.

Hybrid operating rooms are currently used mainly in cardiac, vascular and neurosurgery, but could be suitable for a number of other surgical disciplines.

PLANNING THE HYBRID ROOM

Before planning a hybrid operating room, a clear vision of the utilization should be established. It should address the requirements and the needs of various surgical specialties, procedures and workflow. To ensure a smooth workflow in the room, all parties working together should state their needs and requirements, which will impact the room design and determining various resources like space, medical, and imaging equipment. This may require professional project management and several iterations in the planning process with the vendor of the imaging system, as technical interdependencies are complex. The result is always an one solution tailored to the needs and preferences of the interdisciplinary team and the hospital.

Reference: hybridoperatingroom.com

LIGHTS, MONITORS AND OTHER DEVICES

Multiple movable and flexible booms need to be installed in the OR. If there are 2 booms to be installed, a boom of every side of the operating table should be considered to serve the operating team. Collision of the ceiling mounted display with the surgical lights or other ceiling mounted devices should be avoided. Large displays are now available and capable of integrating multiple video inputs on various sizes and therefore decreasing the needs for multiple screens. A dedicated ceiling plan with all ceiling-mounted components including air conditioning should be drawn to ensure the function and usability of all devices. 

The hybrid OR facilitates a whole new spectrum of cardiac surgical therapies, and will therefore become an essential resource of every cardiovascular centre. The trend towards hybrid OR is more of a revolution than an evolution due to the rapid integration into the surgical techniques. The hybrid OR itself represents an extreme complex working environment that demands careful planning by all stakeholders. Bundling all clinical, technical and architectural expertise as well as a realistic view of what is achievable is key for a successful hybrid OR project. 

Reference: cardenjennings.metapress.com & hybridoperatingroom.com & www.maquet-hybridoperatingroom

Wireless Telemetry System

The Philips MX40 Telemetry device combined with the PIIC iX central monitoring system, is an excellent choice for most hospitals that can expect to leverage the broad networking capabilities and configurability of the system. It may be especially advantageous for larger hospitals that want to access telemetry data and manage system configurations from multiple care areas.

The MX40 device offers most of the features that we believe transmitters with integrated displays should offer to enhance patient safety in many of today's telemetry settings, including:

• The option to have alarms annunciated, and messages displayed, at the device;
• A color display with up to two waveforms, and numeric patient data with alarm limits;
• The ability to silence and pause alarms at the MX40;
• The ability for the MX40 to transition to the functionality of a mini-arrhythmia detection capability and alarms.

Telemetry systems were developed to monitor patients who are at risk for cardiac events but not acutely ill enough to warrant continuous bedside monitoring. Today, they often offer additional measurements that can be used to monitor conditions like hypoxia and compromised respiratory status. Patients on telemetry monitoring are often ambulatory for part of the day.

The IntelliVue MX40 telemetry system comprises the following:

a) The patient-worn MX40 telemetry device, which is used to acquire patient data and relay it wirelessly using Philips' IntelliVue Smart-hopping 1.4 GHz WMTS network or the hospital's industrial, scientific and medical (ISM) 802.11a/b/g/n wireless network.

• The device is powered interchangeably by either a rechargeable Li-ion battery or three AA alkaline batteries and is equipped with a 1.70 × 2.26-inch color display.

• The MX40 monitors ECG, detects arrhythmias, and displays continuous ST and QT segments, SpO2, and impedance respiration, when connected to the PIIC iX or when communication is lost between the device and PIIC iX.

• The display on the MX40 can show numerics and up to two waveforms (i.e., ECG, SpO2, or impedance respiration).

b) The PIIC iX platform, which can be used to control multiple types of Philips monitors across multiple care areas. The PIIC iX includes a telemetry central station, consisting of a PC and one or two flat-panel screens for clinical review. In a networked, multi-care-area configuration, the PIIC iX can be used to easily transfer patients from one care area to another or to allow overview monitoring of multiple care areas.

• The PIIC iX can accommodate up to 32 patients (either single or dual displays, depending on PC screen size).

• Central stations are usually located at unit nursing stations and hallways. Some facilities consolidate patient monitoring in remote areas, where a team of technicians is given responsibility for monitoring central station screens. The PIIC iX is adaptable to either of these models.

• The following diagram depicts the workflow of the PIIC iX platform. Note that the "IBE" shown in the diagram is the IntelliBridge Enterprise, a bidirectional interface between the Philips clinical informatics system and the hospital information systems; it is used to  exchange admission/discharge/transfer (ADT) information, laboratory information, patient orders, and data between the Philips system and the electronic health record. (Image courtesy of Philips).

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 
Source: ecri institute

SOTERA WIRELESS ViSi MOBILE SYSTEM

The Sotera Wireless Vital Signs Mobile system continuously monitors patient vital signs, including pulse rate (PR), heart rate (HR), respiration rate (RR), NIBP, and pulse oximetry (SpO₂), as well as level of motion on adult patients in inpatient lower-acuity care settings. Continuous noninvasive blood pressure (cNIBP) is achieved by taking a baseline measurement with a standard NIBP cuff and then using pulse arrival time to estimate changes from baseline. The system analyzes and interprets vital signs data to alert clinicians to emergent events like high HR or low SpO₂. The system also displays trending data to help clinicians detect early signs of patient deterioration. 

This system offers optional 3- or 5-lead ECG for monitoring purposes (i.e., not diagnostic, and no arrhythmia detection). 

 Central workstation is available and allows control of system for up to 32 patients at a time. Just like the cetntral monitors in the ICU, it can used to:



- Admit and discharge patients
- View graphical and list trends for 3- or 5-lead ECG, SpO₂, temperature, PR, and RR
- View real-time data, including visible and audible alerts and alarms
- Communicate to secondary alarm notification systems or middleware for clinician notification
- Send patient vitals data and alarms to patient electronic medical record (EMR) via an HL7 (Health    
  Level 7) interface.

Remote viewing screen is available for viewing of near-real-time patient data, trending information, and alerts/alarms through WLAN, etc.



The Sotera Wireless Vital Signs Mobile system is a good choice for low-acuity continuous vital signs monitoring applications on a medical-surgical floor. The system has simple patient setup. Trending information is potentially helpful to detect patient deterioration. 
The use of continuous noninvasive blood pressure (cNIBP) is impressive and potentially much more comfortable for the patient than periodic NIBP cuff inflation. Sotera provides the widest variety of alerts for emergent events and status changes. This system is not designed to provide trend alerts or early warning scoring. It is probably best suited to sick patients who need constant monitoring and alerting for emergent events. Battery life is short; two wrist units are required per bed for 24-hour coverage.

System components of the Sotera ViSi Mobile System

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 
Source: ecri institute

Real Time Location System (RTLS)

I thought I write about the system which is really not a biomedical instrumentation but it helps to manage asset by tracking equipment location with ease by locating them during periodic maintenance or in times of clinical needs for the patients where equipment are needed from the various available locations. It can also manage equipment utilization by tracking their utilization time by areas where repurchasing of asset could be kept to a minimum through maximized use of the equipment, etc.

                                                             Figure by courtesy of Ekahau.

In this write-up, the standard wireless-based network 802.11 tracking technology is taken as a model for the function of real-time locating. Where the current hospital or institution wi-fi network already exists within the premises, it actually helps reduce the cost of implementation by piggy-back onto the existing wi-fi infrastructure. 

System Components

 Consisting of an positioning engine that runs on an application software to deliver the visibility of the assets and together with a web accessed Vision software and the required number of RFID active tags, the system with its multiple complex algorithms measures and verifies equipment location, location status over a single unified infrastructure. Active RFID tags wirelessly communicate with the positioning engine to determine the location, etc. 

Methodology

There are many methodology for performing range calculation and they include the following:

• Angle of Arrival;
• Time of Arrival;
• Time Difference of Arrival (TDOA);
• Received Signal Strength (RSS);
• Time of Flight (ToF);
• Symmetrical Double Sided Two Way Ranging (SDS-TWR). 

Linear Accelerator

Getting the Necessary Shielding Right

The use of heavy concrete or ordinary concrete in conjunction with steel to construct the primary barrier of the room is the basic design requirement leading to the construction of the safe facility meant for the use of the medical linear accelerator.

Concrete and Concrete Materials

Today heavy concrete are widely used method for the protection against radiations in Radiation Therapy. Traditionally, it has a limiting effect of heavy aggregates to the baryte gravels and sands. A considerable improvement in the characteristics has occurred, producing concrete with a much higher specific gravity, increasing the density from 3 to 4 if not more to 5.4 which can be realised. These new performance are necessary for widening the common use in radiation therapy.  

Concrete & Metal as a combination

If not carried out correctly, the metal layer could potentially result in a source of photoneutron production where it presents a problem of radiation exposure beyond its shield.  The problem resulting from photoneutron production in the shielding occurs only for the primary beam barriers and not for the secondary barriers. It becomes more pronounce for larger field. To do calculations of photoneutron production, it is necessary to fold the incident photon spectrum into the cross-section curve for photoneutron production as a function of photon energy. 

 

Assuming that bare iron or steel plate or slab is considered, and the neutron production from a lead plate of  1.8MeV for a 15MV x-ray beam to 2.2MeV for a 25MV x-ray beam, the neutron from an iron plate would have a lower average energy because of the high threshold energy. A conservative treatment is to consider 2.2MeV in all cases. If the metal is very thick, the neutron penetrating to the other side will be significantly degraded in energy. A significantly good example is to consider that all the neutrons are created in the first x-ray Tenth-Value-Layer (TVL) and then decrease the average energy in the remaining thickness accordingly to National Council on Radiation Protection recommendation.

The neutrons will be produced in circular areas, typically of the order of 4.5 meters and 3 meters away from the isocentre for the walls and ceilings, respectively. This yields radii of 137cm and 100cm respectively. They are nearly uniform sources, too large to treat as point sources when you are close to them.  At one meter, a lead plate would give a fluence-to-dose of 14 rem/week. For iron plate, it would give 1.7 rem/week. 

Clearly, the above present a true problem that must be alleviate in some manner. This can be accomplished by the use of some neutron shielding materials after or before the metal plate. Preferably one does both the options. Since the photoneutron production is isotropic, if the metal plate is on the inside surface of the room, the neutron will add a small amount of whole body neutron dose to the patient and a certain amount of room activation. X-ray shielding on the inside of the metal plate will virtually always be concrete. The neutron production will be decreased simply by the x-ray attenuation of the intervening concrete. The usual x-ray TVL's are adequate since pair production is not important in concrete.  Note the neutron dose inside the room is attenuated very fast with the inside concrete layer, since the neutron TVL's are less than half of the x-ray TVL's. One x-ray TVL of concrete inside the metal plate will decrease the neutron production by a factor of 10 and will attenuate the resultant neutrons by a factor of 100, in the point source approximation. 

Surgical Light - Implementation Process

Fig 1

Understand the need to decide on the workflow of the surgical process and also the surgeon operating position. The orientation of the surgeon's operating position plays an important role when come to setup design for each piece of operating device and structures that hold the surgical lights, service pendants, monitor screen, etc.

Fig 2

The pictures above (Fig 1) and (Fig 2) show the design plans for the surgical lights and the service pendants. The surgical lights are position at the centre of the operating room. The centre stem holds and supports two main surgical light structures each with a monitor screen. This is a setup for four articulating arms with two rotating axes - one set for the first surgical lights with a monitor and the second set of axis for the second surgical light with the second monitor.

Notice that the circular movements for the articulating arms are an important factor determining a well-planned design so much so that they don't end up fighting for space where the needs arise during the surgery. Next we look at the height of the ceiling below (Fig 3) if there are sufficient space for the surgical lights, pendants, video camera, etc. Depending on the number of stacks/articulating arms to be installed, this ultimately affect the minimum height requirements for the installation.

Fig 3

Next we planned the pendant position where the anaesthesia system would likely be stationed. The other pendants would be for the surgical equipment like the electrosurgical unit, aspirator, physiologic monitor, etc.

Fig 3 - Ceiling Height

Once the design has been firmed up, we need to cater for most important aspects of safety and that is the structural reinforcement of the current or new site where steel structure supports the weight of each piece of installation within the operating site, i.e, the ceiling structure.

Don't forget the next most important part within the operating theatre is also the airflow system. Ensure number of air exchange are not affected by the new installation.

Finally, consider the need to connect up the gases - oxygen, medical air, nitrous oxide, vacuum, gas scavenging, carbon dioxide, the electrical socket, equipotential point, and the LAN point.

LED Surgical Light

From halogen to LED lightings. LED technology has been around for many years and until quite recently, the development of LED into surgical lightings has taken a new evolvement with benefits to the light characteristics. Its

  benefits are aplenty: low heat thereby reduces energy consumption; multi-lens matrix combination creating 3D perception effects where lights are distributed and the effect is a homogeneous and shadow-free light output; excellent lifespan mininises outage, etc.

Da-Vinci Robotic-Assisted Surgery

The use of robotics minimally invasive techniques minimize the physical and emotional impact of surgery on patients. Robotically-assisted MIS represents a third generation of surgery, one which builds upon the advances to open surgery introduced by MIS. Robotic technology takes surgery beyond the limits of the human hand, introducing precise, versatile instrument movement combined with three-dimensional visualization of the operative site. With minimally invasive surgery, the goal is to accomplish internal repair while leaving the body surface as natural as it was prior to surgery. Many procedures require only several days in the hospital and promote reduced recovery time. Patients can often get back to their normal routines more quickly.

The new Da-Vinci Xi system is optimised for complex surgery with:

• A new overhead instrument arm architecture designed to facilitate anatomical access from virtually any position. 
• A new endoscope digital architecture that creates a simpler, more compact design with improved visual definition and clarity. 
• An ability to attach the endoscope to any arm, providing flexibility for visualizing the surgical site. 
• Smaller, thinner arms with newly designed joints that offer a greater range of motion than ever before. 
• Longer instrument shafts designed to give surgeons greater operative reach. 

The system is capable of being operated from just about anywhere, it's most common to have the surgeon sitting right next to it, in the operating room with the patient. The benefit of the Da Vinci system isn't really the potential for remote access; instead, it's that the surgeon can use tiny robotic tools that mean a much smaller incision, along with visual enhancements like infrared imaging that provide valuable information than their eyes might not.

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 
Reference: www.intuitivesurgical.com

A Perspective Freehand Sketch of an Operating Theatre

In designing Operating Theatre, once must look at the importance of accesses to the surgeon and nurses in terms of electrical power, light intensity, medical gases, etc. Light intensity must be strong enough as to provide the correct color temperature, intensity, focus (effectively suppose to be shadowless) and penetration, etc.

You will notice that two gas pendant arranged diagonally to provide gases for the anaesthetic unit. The gas pendant also serves as an electrical bank for all surgical equipment. Additional electrical sockets can be found on the walls.

The other aspect of design is the ventilation system, the number of air exchanges. Loading factors for the ceiling to take the load of the surgical lights, gas pendant, monitor screens, cameras, etc need to be factor in before the start of the implementation.

A fresh start............

Has just started this blog. Will have more posting in the months to come.