An OR table executive was only half-kidding when he said you could do surgery on a dining room table. Indeed, you want a rock-solid platform to do surgery on, but your table is really only as good as the accessories that make it multi-functional, the positioning devices that adjust to the patient and the size of the C-arm window.

Further, surgical tables are a bit more expensive than dining room tables, generally ranging in price from the low-30s to the mid-40s. Specialty tables can run as high as $60,000. And there are several table types to consider. Do you want a general table system that can handle specialized procedures and imaging? Would a mobile operating platform that transports the patient from pre-op to OR to PACU work for you? How about an imaging table that also serves as a platform for minor surgeries? Whichever you'd choose, let's take a look at a few features you might want in your next table.

Add versatility and flexibility
In today's fast-paced surgical environment, flexibility and versatility are keys to choosing the right surgical table. You don't want to be locked into a narrow case mix because you can't easily convert your general purpose surgical table into an orthopedics table, for instance. Specialized attachments can address this situation. In the case of some ortho procedures, it's abductor bars that make the difference. Trendelenburg braces and table extenders that convert a standard 20-inch-wide table into a 28-inch-wide one let you handle bariatric cases. You can remove the head from a table and replace it with a horseshoe positioner for laminectomies. Add $5,000 to $9,000 shoulder chairs to your table to handle upper-extremity surgeries. You can add OB/GYN and urological procedures to your case mix by buying stirrups for $4,000 to $5,000. The point: You don't have to buy a specialty table; a general table is just fine as long as you have the right accessories.

Good accessories will also be convenient for nurses and surgeons to use and enhance patient safety and comfort. Surgeons want attachments that give them the best access possible. Allen Medical, for example, says you need only attach its shoulder positioner for unobstructed posterior access, not to mention the ability to perform rotator cuff surgery on a general table. The positioner's gas piston design is said by the company to ease the moving of the patient - which nurses want and need, as mechanized positioners can prevent injuries.

Perhaps you want to operate on bariatric patients. In addition to table extensions, you can get reverse Trendlenburg straps that encircle the inner thighs and keep the patient's weight from pushing back on his shoulder blades.

Neurology cases on your plate? Getinge offers a spinal frame accessory. You can also attach neurosurgical head supports and headrests as you adjust the table to a chair position or a horizontal position.

Urology cases? On Berchtold's tables, you can remove the back section from a table and replace it with a urology extension that has a perineal cutout, which makes it look like a horseshoe. You can also attach a fluid collection system beneath. Skytron's tables have an Uro Drain Tray you can attach at the leg or head end.

Also remember that accessories and positioning devices should be adjustable to the patient's location, not vice versa.

Surgical hand tables can be easily mounted to procedural tables with a universal bracket. New Medical Technology offers a UniTable made of carbon fiber and supported by a single pneumatic leg that can be manipulated for minute height adjustments.

Nerve injuries happen when anesthetized patients' limbs are over-abducted. Stretched sciatica nerves, for example, occur when legs are placed in outmoded candy cane stirrups used for OB/GYN and bariatric procedures. There are ways to keep patients - and staff - safer. Powered-lift stirrups from Steris and Getinge, and Allen Medical's Yellofin Elite Stirrup ease lithotomy positioning because they do the lifting for nurses, who would otherwise have to drag or hoist the patient's legs. Berchtold also offers boots with gel pads in the calf and heel that have complete articulation capability to prevent plantar fasciitis.

Headrests - and the ability to adjust them in three dimensions - are key on procedural chairs for plastic surgery, ophthalmology and ophthalmic laser surgery. Dexta's Mark 80XYZ offers motorized adjustability. PCI Alliance makes a three-point headrest that tilts the head, which helps plastic surgeons get around the skull for facelifts and hair transplants.

Procedural chairs can also be modified for versatility. For example, if you add a drain pan to PCI Alliance's chair, it becomes a urology table; attach stirrups to make it an OB/GYN chair. There are also modular surgical tables, which can be outfitted to your needs in the most cost-effective way. Trumpf's Titan comes as a basic seat and lower back section. You purchase everything else as modules. The units are joined together with mechanically coded coupling points so you can't make a wrong combination that could damage your table tops.

Double-duty imaging tables
There's a big push to have intra-operative imaging tables for hospitals and ASCs so they can handle more productivity and give you more flexible functionality. Fluoroscopy tables can now handle minimally invasive peripheral vascular surgery, prostate seeding, pacemaker placement and more.

Morgan Medesign's MPSeries is one example of a multipurpose C-arm table that you can use for minimally invasive surgery. HealthTronics' latest imaging table, the MultiVantage, has a table top that can be pivoted 90 degrees to get out of the field of the X-ray beam for use as a surgical table. Allen Medical Systems' Universal Imaging Extension lets you turn a standard OR table into an imaging platform.

Even today's urology imaging tables don't just do urological procedures. Both HealthTronics and Biodex have urology imaging tables that can handle other specialties like gynecology, cardiovascular, pain care, gastroenterology, orthopedics and ENT. You just add extenders to the Biodex table.

C-arm capability
Sliding tabletops let you push the table to extremes, which increases your C-arm window. You should never have to reposition the C-arm to the patient to take an X-ray. Sliding tabletops let you reposition the patient without having to slide or drag the patient yourself. You don't want to be removing sections of the table or rotating the patient, so determine your image coverage before table shopping.

Skytron's UltraSlide 3600B offers a 23-inch top slide, which provides up to a 57-inch imaging window. Steris's Cmax longitudinal slide allows up to 43 inches without the need to reverse patients. Berchtold's 12-inch sliding table top has 19-inch-wide imaging window. This lets you X-ray bariatric patients, whose organs may cover a wider area, in one shot.

A metal-free radiolucent area will ensure unobstructed imaging for full image amplification. The tabletops on Getinge's Alphamaxx, Biodex's C-Arm Table 846 and products from Surgical Tables, Inc., are designed without metal crossbars.

Biodex, GE Medical Systems, HealthTronics and Morgan Medesign have floating, four-way tabletops so you can adjust the table in the X-Y plane. Some tables also tilt in any orientation, like the one Morgan offers. Instead of waiting for the processing time of film, companies like Liebel-Flarsheim and HealthTronics offer a full digital system to speed the diagnosis.

Power to the table
It's an industry standard now to have electric and battery power options. But consider backup systems like the manual foot pump that Berchtold and Steris offer. Berchtold also offers auxiliary manual controls if the power options are inoperable. Steris boasts an Intelli-Power dual power system for batteries or live current with a manual override system. On the opposite spectrum of controls, Skytron's Model 6002 offers voice and touch-screen activation.

You should also be able to reorient the table at the push of a button - no more guessing what's level and what's the home position. Some companies, like Biodex, Reliance and Dexta, offer controls that have back-to-home and back-to-level keys that automatically take the patient where they need to be. There are also several memory presets so the table can adjust to whichever doctor is performing the procedure, whether he's 5 feet 6 inches or 6 feet6 inches.

Many tables, like Berchtold, Steris, Biodex and VisionEquip, have hand pendants that are attached to the tables. There are even wireless hand controls to adjust your table. Morgan Medesign offers this feature as a standard. The Welner Legacy Table is electrically powered and features a height range of 18 to 39 inches, which lets you transfer bariatric, geriatric and wheelchair-bound patients more easily, says the company.

Most procedural chairs, like PCI Alliance, Dexta, Reliance and VisionEquip, have foot pedals as standard features rather than hand pendants. Reliance also has dual side controls on the chair itself. Liebel-Flarsheim's urology table has a foot pedal for quad mode magnification.

Higher weight limits
Weight has never been such a burdensome issue as it is now. An estimated 127 million adults in the U.S. are overweight. As a result, the number of surgery patients who could be classified as obese has risen dramatically and tables for all procedures need to hold at least 400 pounds.

The Skytron Hercules 6700B strong-arms the other operating systems tables with a weight capacity of 1,200 lbs. and 1,000 lbs. in articulate capacity. The Steris comes close by handling 1,100 lbs., but its patient posturing limit is 600 lbs. The Getinge Alphastar Plus recently increased its weight capacity from 800 lbs. to 1,000 lbs. with full articulation.

Mobile surgery platforms' limits are lower; Stryker's Trio and Techlem's Premier Series 5000 each hold 500 lbs. Techlem also says its side rails can handle 500 lbs. in case the patient rolls over.

Imaging tables range in weight limit from the Morgan table's 400 lbs. to the Liebel-Flarsheim Urology table's 750 lbs. The Oakworks table uses a dual-towered base design instead of a cantilever design. Its weight capacity is 550 lbs., but costs considerably less than most imaging tables - $6,000 to $10,000 compared to more than $15,000, says the company.

Procedural chairs range from 450 lbs. to 600 lbs., and Reliance and Dexta make chairs that handle the higher end.

Vertical articulation also helps you deal with bariatric patients. You can lower the patient for easy access if you're standing above them or seated on a stool. The Skytron UltraSlide 3600B drops to 24 inches; most others go to 26 inches. Berchtold's tables descend to 28 inches but have a built-in X-ray cassette channel, so you don't need to buy a bulky, expensive X-ray top. PCI Alliance's mobile operating chairs drop to 18 inches.

Mobile operating tables
In an outpatient surgery center environment where stays are short, a mobile surgical table might be your optimal solution. Patients can stay on the same platform for pre-op, the surgical procedure and post-op recovery. This eliminates patient transfers, which result in back injuries to staff members and workers' compensation issues. Also, this system reduces room turnover time, which results in more procedures and more profit for the ASC.

There are many options offering increased mobility as nurses cart patients from pre-op through to recovery.

The Techlem Premier Series 5000 and the Stryker Trio both use a fifth-wheel steering system, meaning there's an extra wheel that drops down from the center of the bed. This stability helps prevent you from steering the table into a wall. The Techlem table has a coil spring system so its fifth wheel is always in contact with the floor, no matter how uneven its surface, says the company.

Handling is also improved on the Techlem with offset casters that prevent wheel conflicts. It also has brake steer pads on all four corners and a system brake system to engage each. Though the Techlem is considered more of a stretcher procedure table, minor procedures, such as endoscopies, are increasingly being done on stretchers.

The Getinge Alphastar and Trumpf Titan are motor-driven, enabling just one person to push the tables. With the Alphastar, it's just a push of a button with the optional auto-drive feature. The Titan has electric motor-driven joints and extendable feet, along with a motor-driven running gear that does most of the work when transporting patients.

Once your patient arrives in the OR for surgery, though, you might want to be sure the table isn't going anywhere. The general surgery table from Advantage Medical Systems has a unique patent-pending design that raises the caster wheels and lowers the table to sit on a combination of short feet and bars attached to a flat base plate, says the company. This keeps the surgical platform stable while also lowering the table height for less invasive procedures like endoscopies and laparoscopies.

Also, determine what kinds of procedures you can do on these all-in-one platforms. Stryker's Trio Mobile can handle the most common surgical procedures in ASCs, says the company. Once a patient is finished with recovery, the table can easily be brought to its home position for the next patient.

You can place the Trio Mobile in the beach chair position for shoulder surgeries; there's even a cutout to examine the shoulder from the back view. The foot section is removable for lithotomy positioning and a cysto pan tray can be pulled from underneath the table like a drawer for urological procedures. There's also an option for a foot-end backrest attachment with a dual articulation headpiece for ENT and ophthalmologic procedures.

Similarly, VisionEquip's mobile surgical platform can handle ENT, plastics, ophthalmology, oral and maxillofacial surgeries. It even goes into true Trendelenburg, says the company. Reliance makes a chair that allows for blocks and can go to a near 180 degrees.

Buying your next table
As you can see, table manufacturers have given you many choices; you're bound to find a table that fits your wants and needs. Just remember to choose accessories that increase the functionality of your table and that adapt to patients rather than forcing patients to adapt to the table.