2.1 Operating Room Setup and Positioning

Operating Room Setup

The operating room should be set-up such that the patient, surgeon and assisting staff are comfortable, close enough to handle instruments, and have good visualization of each other, the vitrectomy machine, and any video monitors. In general, the surgeon sits at the head of the patient, with the anesthesiologist / anesthetist on one side and the vitrectomy machine on the other. The operating assistant sits temporally on the side of the eye being operated, and the nurse is located temporally on the contralateral side. Alternatively, assistant and nurse are in fixed positions on either side regardless which eye is being operated on.

The operating machine table or a Mayo stand is useful for supporting the infusion line / hand-piece cables and for holding equipment other than those on the instrument table. This should be high enough that the sterile drape forms a tent to give the patient room to breathe and allow the anesthesiologist / anesthetist access to the patient.

Patient Position

It is important that the patient’s head be as straight as possible. Excessive neck flexion or extension is uncomfortable for both the patient and surgeon. Some surgeons prefer a slightly extended neck position to provide greater access to the superior retina. This will depend on the eye position following local anaesthesia, which may not be in primary. Some surgeons prefer to use a head ring (“donut”) and a wrist rest. The wrist rest also can be used to create a well between the patient’s head and the rest, which collects excess irrigating fluid. Other surgeons prefer to rest their wrists on the patient’s forehead to help stabilize the head. Stabilization of the head in un-cooperative patients can also be achieved by immobilizing the forehead with surgical tape.

Surgeon Posture

Ophthalmologists have a high rate of chronic occupational injuries due to the repetitive and ergonomically challenging nature of the positioning required in the operating room. Surgeon posture is important both for the surgery being performed as well as for the surgeon’s long-term well-being. The set-up of the surgeon’s chair, the patient’s bed, and the microscope are important.

  1. The surgeon should sit in the chair in a comfortable position when the feet are on the foot pedals
  2. The patient’s head should be at the very top of the bed. The helps reduce the need for the surgeon to lean forward toward the microscope and patient
  3. The bed should be wheeled into position and the height adjusted so that that the eye is at the appropriate height. The surgeon’s forearms should be parallel to the floor
  4. When learning how to establish good posture, the microscope should be positioned such that the surgeon is looking straight ahead or slightly down. The inter-pupillary distance and ocular focus should be adjusted

Good posture allows for safer operating and prevents work-related injuries. Digital visualization and heads-up displays may improve ergonomics for surgeons.

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1 Preoperative Considerations and Anesthesia

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Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.

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