When it???s time to shop for new surgical equipment, there???s no place quite like the Annual Congress of the Association of Perioperative Registered Nurses. It???s one of the top 10 largest trade shows in terms of exhibit hall space in the United States, and it???s easily the largest meeting for perioperative nurses in the country. It???s also traditionally where surgical manufacturers unveil new products. Unfortunately, fewer than 7,000 nurses get to attend the show each year. So, in an effort to help those who couldn???t attend, I trekked out to Southern California, notebook in hand, to find and report back on the news from the exhibit hall.

To help me narrow my task, I confined my quest to capital equipment— surgical lighting, equipment service booms, integrated OR controls, endoscopic suite technologies, surgical instruments, sterilization and materials handling. I only included items that were truly new, which I defined as not present at last year???s AORN. I excluded what I considered to be "me-too" products—those which appeared to offer no unique benefits over existing products—and those which appeared to me to be mostly bells and whistles.

I tried my best to completely tour the 530-company exhibit hall in the two and one half days allotted, but undoubtedly there will be gaps in my coverage. To the companies I missed, my sincerest apologies in advance; please write us and let us know about our omissions and we will attempt to report them to our readers as soon as possible.

With those caveats in mind, here???s what I saw at the AORN.

Surgical Lights
Perhaps the most remarkable thing I saw in this area of mostly mature technology was Steris Corporation???s Harmony lights. They are so new that they aren???t even available yet—the FDA has not granted them a 510k. The company believes they may be ready for sale by late summer.

In a lot of ways, the Harmony is similar to other light systems on the market. It comes in small, medium and large. The small one, which is 10 cm in diameter, comes with a light output rated at 5,500 foot-candles. It might be appropriate for an emergency room, exam room or a minor treatment area. The medium lamphead has a 20 cm lens rated at 12,000 foot-candles. This one would be suitable as the principal light in a general OR. The large one is 26 cm lens in diameter with a maximum output of 13,000 foot-candles; it???s targeted for major surgical suites. The medium and large lampheads come ready for light handle-mounted cameras and the arms and intensity controls are pre-wired for video. Plenty of other lights can essentially say the same.

What may make this system different from other light systems is its flexibility. Essentially, it allows you to upgrade your lighting system without switching out your light arms—you can put small, medium and large lampheads on the arms on an interchangeable basis.

Here???s how it might work. Say you???ve built a three-OR orthopedic outpatient surgery center with the intention of doing traditional arthroscopy and fracture fixing there. You select the Harmony light with the medium sized lamphead. Two years later you decide to do total joints at your facility. You need to upgrade at least one lighting system for deep wound illumination. With the Harmony, you would not have to tear out the light arm. You would just swap your medium lamphead for a larger one and have a technician install it.

A couple of other details:

• The video arms allow facilities to change from CRTs to flat-panel displays with a simple bracket change on the end of the video arm;
• The surgeon can adjust the lamp intensity via the sterile light handle. The variable intensity controller offers seven steps of illumination;
• The Harmony also works with the DeepSite fiberoptic tubular light, which was introduced two years ago at the AORN.
• The arms and lampheads are pre-wired to accept video at a later time.

Surgical Tables
Surgical tables are a relatively mature technology, and many of the improvements of late have been in the "bells and whistles" category. However, one improvement that???s real is the move toward C-arm compatibility. Lots of the tables on the market today are radiotranslucent, with less metal than ever, and set up so that you can move the patient rather than the C-arm (and the lead shields) when you need a new view.

Many of the new tables I saw at the AORN all had features along this line.

Biodex introduced a cantilevered Surgical C-Arm Table that floats in both the X and Y direction when you activate a handgrip on the accessory rail. The table is aimed at cardiovascular procedures. The company says the carbon fiber tabletop offers an extra-large radiolucent area. This company also introduced an interesting no frills, "fixed-height" C-arm table. The table has the same radiolucent surface, but it doesn???t move in any direction other than back and forth on rollers. The company says the table will work for pain, gastroenterological and vascular procedures. The price is well under $10,000.

Skytron introduced three more OR tables to the company???s already extensive product line. The battery-operated Opera is designed specifically for outpatient surgery. It can lift patients weighing up to 600 pounds and it allows you to manipulate (or articulate) the table with a 400-lb. load on top. It???s not designed for use with C-arms.

The Model 3001 is a radiolucent flat top table with a four-way floating top specifically designed for use in vascular, pain management and other image guided procedures. It has a 400 pound weight capacity and an optional sterile one-touch joystick control.

The Model 6600 is a major surgical table that has a 1,000 pound lift and 600 pound articulation capacity. You can get the removable back and leg sections in a radiolucent carbon fiber material. This table allows you to spin the surface around so that you get great access to the patient???s north or south end. Don???t do it while the patient is aboard, though.

Trumpf is bringing to the U.S. market the Mars EndoUro radiolucent table. With a footswitch, you can cause this table to move 20 inches from head to foot and seven inches side to side, a useful feature for urology, pain management, brachytherapy and other procedures. The table movements and articulations are all directly driven by electromotors—there are no hydraulics, which means there can be no hydraulic leaks (this is uncommon in my experience). A neat feature is a built-in modem on the table; when something goes wrong you can hook it up to a phone line and somebody at the home office can diagnose the problem long-distance.

Steris introduced two new radiolucent tables, the SurgiGraphic 1027 and the SurgiGraphic 6000. Both are designed for use with a C-arm. The SurgiGraphic 1027 is a height adjustable two post table with a 500 pound weight capacity; it has an exposed frame with 6-inch casters and resembles a stretcher. The SurgiGraphic 6000 is more akin to an operating room table. It has a four-way floating top, customized programmable pendant control, a 500-pound weight capacity, concealed swivel casters and electric floor locks beneath a stainless steel base cover. Both accept a specially designed accessory side rail clamping system that will accept any standard rail-mounded OR table accessory; these rail clamping assemblies easily detach for metal-free imaging.

Equipment Service Booms
Booms are another area where the technology is relatively mature. Early booms didn???t have enough load capacity and they were hard to move around. Newer booms have better bushings, bearings and assemblies and for the most part work relatively well. I saw new booms at the AORN, but frankly I didn???t see any developments that I would term astonishing. Here???s a quick rundown:

Getinge/Castle showed its new ALM Modulis Evolution ceiling mounted equipment organizer. The best thing about it may be its cosmetics—I thought it looked sleeker than some of its competitors. The device features greater load capacity, longer arms and increased maneuverability over previous ALM service booms, but I have to say that I???m not sure the old booms were all that bad in those departments. The boom allows you to turn the equipment and accessories 360 degrees. Like its competitors, the Modulis Evolution can be configured with medical gas, electrical, data, phone, and video connections.

Berchtold also has a new boom, called the Teletom 700 power boom. Improved features include an increased equipment weight capacity of 350 pounds and a redesigned bearing system that makes it easier to brake and park. Also, there???s a brake on both the front and the back of the boom for convenience. The company has also increased the number of available spaces for medical gas, electrical, data, phone, and video connections.

Trumpf was not displaying new booms, but announced that it is now directly selling its Kreutzer line of surgical booms. Previously, the company had used distributors. The booms have a long reach and a heavy load capacity. Skytron was showing a new small profile boom. The Mini-Equipment Carrier is available as fixed-height or power adjustable. It has dual friction brakes at each bearing and is 50 percent smaller than traditional booms, so it???s easy to move. An innovative feature of these monitors is how they get the large CRT monitor off the boom and use flat-panel monitors mounted on arms off of the OR light hubs. This reduces bulkiness and lets the surgeon place the video screen where he wants.

Integrated OR Controls
There are a number of devices on the market that integrate some of the controls for operating rooms into one panel, saving steps for your circulator. A new one I saw was Getinge/Castle???s Operating Room Control System.

Unlike some competitive systems that "interface to anything in the OR" and "tie your OR to a global network with touch screen, voice or keypad controls, etc.," this one seems grounded in reality. It supports the circulating nurse by providing a single touch-screen control for the OR lights, room lights, video routing and printing, and the room???s stereo sound system. It also interfaces with a PC workstation and with Getinge/Castle???s T-DOC instrument tracking system, and it has an open architecture design to allow for customization and interface with various pieces of equipment.

Endoscopic Suite Technologies
In the Buck Rogers department, there was Stryker Endoscopy???s OptiVu HDVD, an imaging system that allows surgeons to view high-resolution images through a lightweight eyeglass-mounted display. The concept is not new, but I found the image to be especially bright and crisp and the headgear much lighter than similar products. Perhaps the most significant feature, though, was its wireless nature; the video is transmitted via infrared signals which allow full mobility around the surgical field. Infrared transmission also means there is no radio frequency cross-talk from other devices in use.

The OptiVu HDVD system consists of three main components, the OptiVu Base Station, the Wireless Infrared Transmitter and the Digital Video Loupes. The device will accept S-video and RGB inputs. I would not be surprised to see this technology become more prevalent than video display monitors one day. However, right now it is much more expensive.

Stryker also had a new digital camera, the 988. The most interesting thing about it was that it had a Firewire output in addition to other digital and analog outputs. Firewire data transfer is extremely fast. The camera unfortunately is not autoclaveable.

If you want to get into surgical robotics but don???t have the budget, you may want to look at Biomec???s S.A.M., or Surgical Assistant Module. You might call it the poor facility???s surgical robot. This device mounts on the OR table rail and acts as a "third arm" for the surgeon. A gripper on the end can hold a retractor or endoscope in a fixed position. The arm articulates at several knuckles and is extremely stable, being fixed by a pneumatic braking system. The result is highly adjustable but stable positioning of an endoscope like a surgical robot, except that the surgeon or first assistant has to position the device. Its cost is a fraction of the cost of a surgical robotic system.

Surgical Instruments
Cords and hoses at the end of powered orthopedic devices can be cumbersome and potentially bring contaminants into the sterile field. They require sterilization, maintenance, and organizational effort, since different tools have different types of connectors.

A new line of battery-operated Hall Surgical Power tools from Linvatec promise to help rid your OR of spaghetti. A nifty feature, called the Surecharge sterilization charging case, allows you to charge the NiCad batteries while they???re still in the case, after they are steam sterilized. The company thoughtfully provided the rotary handpieces in three different trigger configurations designed to feel like the nitrogen handpieces, so surgeons won???t get thrown for a loop. There is also an oscillating saw handpiece. A special feature of the two-trigger PRO5200 rotary handpiece is that it offers both screw and tap modes.

ValleyLab added two new instruments to use with its LigaSure system, the LigaSure Precise small vessel sealing instrument that is said to be handy in head and neck surgery, and the LigaSure Atlas laparoscopic sealer/divider that with one trigger grasps and seals the tissue and with another trigger articulates a blade to transect the sealed tissue bundle. To my surprise, I discovered that the Atlas is not approved for tubal ligations. The system acts on the collagen in the tissue and Fallopian tubes have a low collagen content and are not reactive enough.

Smith & Nephew has purchased the orthopedic specialty company Instrument Makar and rolled that company???s catalog into its instrument product offering.

Surgical Equipment
I liked the looks of Pedigo???s new P-1080-6 infusion pump stand. Anyone who???s used one of these devices knows they can be clumsy and even top-heavy, and especially hard to use if you are a vertically challenged individual. This one has a sturdy five-leg 32-pound mobile base with three-inch casters. A great feature of the heavy duty six-hook IV pole is the bag drop prevention device that allows controlled descent of the pole. There are also some convenient features—power outlet strips, an oxygen holder, wire baskets and universal accessory clamps.

In the sign of the times department, Blickman???s new 8000 Series stainless steel surgical scrub sink incorporates infrared faucet sensors as a standard feature. The old-fashioned knee controlled faucet is optional equipment! The scrub sinks are available in one, two or three bays in both wall mounted and floor models. The company also had a new jumbo Mayo table with elongated flat base legs and double posts for strength and stability.

Sterile Processing
Teaching hospitals often find that their instruments walk out the door. They may find utility in Getinge/Castle???s T-DOC 1000 instrument tracking system, which helps you follow instruments throughout the distribution, use and reprocessing cycle. The system provides archived information that the company says will offer the facility "traceability, security, and savings" and "quality assurance of sterile production." Systems like this may also have a place in the fight against bioterrorism and Creutzfield Jacobs disease, which is caused by prions that are impervious to steam sterilization. I???ve heard of one hospital having to throw away hundreds of thousands of dollars worth of craniotomy instruments because it couldn???t identify the set used on an infected patient.

Getinge/Castle also introduced two new steam sterilizers, the 400 HC/LS and 500 HC/LS. Incremental improvements include a control panel which the company feels is easier to use and a little more capacity.

A new tabletop sterilizer from SciCan incorporates a nice feature for preventing wet packs. The QuantIM 16 countertop autoclave has a vacuum that allows for closed-door drying of wrapped loads. Other such sterilizers require you to crack the door. The QuantIM features a 16-liter chamber that???s 10 inches in diameter and 13 inches long; it will accommodate up to three standard Hu-Friedy 8x10-inch wrapped instrument cassettes. This sterilizer would be a good fit for outpatient centers doing cases with small size sets like ophthalmology.

Imaging
A new C-arm from General Electric-OEC looked like it could be a worth a look for some freestanding outpatient surgery centers. The FlexiView 8800 digital mobile fluoroscopy system is about half the price as the cheapest version of its big brother, the model 9800, which runs from $120,000 to $250,000. Yet it has the same dual high-res monitors and the same image processing software, offering convenient comparison of crisp still images. It???s also smaller, lighter and easier to maneuver than the 9800. The catch is that you can???t do cross-table laterals with the 8800—the anode is stationary and doesn???t pack as much punch as a rotating one—so I wouldn???t recommend this for pain management. It also provides only static rather than dynamic images—the 9800 has much more image processing capacity.

Materials Handling
Cari-All Healthcare has a new line of modular wire storage shelving finished in powder coated epoxy. The company believes this to be a superior finish for wire shelving used to store wrapped sterile goods because there are no sharp edges or wire ends that could tear the wrapper.

Patient Care & Safety
One of the most innovative products I saw was made by Advanced Surfaces. It is a patient warming system that is incorporated into a fluid resistant, pressure reducing pad. The pad is covered in a special material that becomes warm when an electrical charge is applied, and the pad only becomes warm where the patient is touching the pad. This is nothing like your mother???s heating pad or electric blanket. There is not excessive heat spilled into the room, thus the product???s name Cool/Heat.

Cool/Heat is a direct warming system that allows complete access to the patient since the heat is coming from the pad beneath the patient and not from an air-blown heating blanket on top of the patient. The company says the pads are designed in such a way that they can not get hot enough to cause hyperthermia or burn a patient. The heating element is radiolucent, contains no wires and the temperature can be controlled within one degree.

The Cool/Heat approach is to not let the patient get cold, so you are not faced with the associated risk factors of mild intraoperative and postoperative hypothermia. Company representatives say the payback on these permanent pads is a result of savings of both hard and soft costs related to disposable air blankets and extra linen used to warm patients.

Advanced Surfaces makes pads for any make and model of stretcher, OR table, and cath lab table. The pads are radiolucent, so they???ll work with C-arms. The power and precise temperature controls for these pads are contained in a separate power supply box that can run off battery power for 10 hours.

If you are in the development or operation of outpatient surgery centers and have never attended an AORN Congress and visited the exhibits, I would strongly encourage you to do so. The chance to see "everything OR" in one place is a great educational experience. The Association of Perioperative Registered Nurses has opened their ranks with Associate Memberships for non-RN???s. For $65 annual dues, you get access to the benefits and resources of the AORN as well as receiving the AORN Journal that contains original peer-reviewed papers as well as topics of interest to those involved in surgery. Log on to www.aorn.org for more information.