Chapter 6
Theater Table
(see Video 3: Fulcrum of operating table)
Video 3 Fulcrum of operating table
In an ideal situation, the table’s fulcrum should be in its middle rather than towards the head. This is an important point, because if the fulcrum of the table is close to the head end, then, use of the Trendelenburg position raises the height of the patient’s abdomen. This, in turn, severely limits the surgeon’s hand movements, making the operation cumbersome if not increasing the risk of injury (Figure 2). It is mandatory that the theater table should allow 30–50° angulation and the height be adjustable.
As already mentioned, table height should be at or below the waist line of the operating surgeon in order to avoid muscular fatigue from the non-physiological position of the surgeon’s arms during the procedure. Space around the table must be sufficient to allow proper positioning of instrument trolleys, anesthesia workstation, endovision cart, and ancillary equipment which may include but is not limited to the electrosurgical generator, body warmer, and deep venous thrombosis (DVT) prevention pump. In addition, there must be space for the principal surgeon, surgical assistant, anesthetist, anesthetic assistant, and scrub and circulating nurses.
It is advantageous if the table height can descend to the floor level in the event of unforeseen complications which require cardiac resuscitation.
When Allen type stirrups are not available, a reasonable alternative is to place the lithotomy rods in a position which approximates the angulation required for the laparoscopic procedure. In other words, the thigh and the knee should proceed forward in a plane that is level with the abdominal wall, rather than be brought up towards the knee chest position.
The authors prefer that the mechanical control of the theater table be in the hands of the anesthesiologist. This dictum must be followed regardless of whether the table is mechanically or electrically operated.