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Proctoscopic attachment for operating room table
PROCTOSCOPIC ATTACHMENT FOR OPERATING ROOM TABLE R. RUSSELL BEST, M.D., Assistant
Professor of Surgery, University OMAHA,
A
LTHOUGH the knee-shotrIder position is adequate for routine proctoscopy, it not infrequently proves awkward for both the patient and the doctor when the examination or operative procedure is proIonged. Even in this position, the end of the proctoscope near the examiner’s eye wiII occasionahy be Iower than the end within the bowe1, so that any retained enema soIution or Iiquid secretion may run into the instrument and prove most annoying. For the weak, elderIy or incapacitated patient and in operative work through the proctoscope, as obtaining a biopsy or removing a polyp, this position is especially fatiguing for both the patient and surgeon. The Iithotomy and IateraI positions are mentioned only to be condemned. In every instance, the most satisfactory position for proctoscopy is the inverted or Hanes’ position. There are proctoscopic tabIes idea1 for the off&e but as they are designed soIeIy for use in recta1 procedures, their use in hospitaIs wouId require expenditure for a tabIe unsuited for genera1 operative work and a separate room for the table, unless it can be isolated in a corner of one of the operating rooms or the haIlway. This expense and the additiona space required are hardIy warranted. Up to this time, no modification in these tabIes has been presented which wiI1 Ii11the genera1 operating room requirements and stiI1 be advantageous for proctoscopic and recta1 manipuIations as the various positions required in genera1 operative work have prevented the manufacture of a tabIe with a hip break adaptabIe to the requirements of proctoscopy. With these factors in mind, I have designed an attachment for an
F.A.C.S.
of Nebraska
I\IedicaI ColIege
NEBRASKA
operating tabIe which in no way interferes with its general demands, and yet permits the patient to be placed in the inverted position for recta1 procedures. This attachment shouId be used on tabIes which have a hydra&c pump control on the foot leaf. Since a11 genera1 operating tables are constructed with no break at the angIe of the hip, the patient must be turned so that his head is toward the foot of the tabIe. This brings the knee break at the correct pIace for the hip ffexure and by Iowering the foot Ieaf the patient can be pIaced in an inverted position. The referred attachment consists of a sheet of heavy meta molded to a right angIe and attached to a pair of horizontal bars fitted with grips which fasten to the heavy side raiIs at the foot end of the operating tabIe. The vertica1 portion of this meta sheet measures 13 inches in height and serves as the platform on which the head and eIbows rest when the patient’s body is flexed. The 7 inch horizontal meta sheet serves as a support for the horizonta1 bars. These heavy bars are 14 inches Iong and extend onto the vertica1 meta sheet for reinforcement. Bars of Iighter metal angIe across from the platform to the heavy horizontal bars for further support. There must be no cross bar support for a space of 7 inches between the horizonta1 bars at the tabIe attachment end to aIIow for cIearing the foot of the tabIe and for adjustment according to the height of the patient. After the attachment is secured to the foot of the operating tabIe, a foIded bIanket is Iaid on the vertica1 pIatform and on this one or two pihows are pIaced. The usua1 table pad is used. The patient’s head and eIbows rest against the piIIows and the
382
American Journal of Surgery
Best-Proctoscopic
hands grasp the edge of the platform which has been protected by the bIanket. By means of the hydrauhc pump, the Ieg sec-
FIG. I. The apparatus
is attached to the foot end of the table.
tion of the tabIe is graduaIIy dropped and the patient’s head gentIy lowered until he is in the inverted position. Since it is possibIe for the leg section of the tabIe to descend too rapidIy, it shouId always be supported to assure its Iowering sIowIy. With the ScanIan-BaIfour operating tabIe, a fitting with check can be supplied which wiI1 prevent the too rapid Iowering of the Ieg section of the tabIe. After compIetion of the proctoscopic examination, the end of the tabIe is eIevated by means of the pump. If the examination is to be foIIowed by any type of operative procedure in the prone, lithotomy or side position, the attachment is removed and the tabIe pad and patient are rotated on the centra1 axis of the table
Attachment
MAY. 1936
unti1 the patient’s head is at the usual’head of the tabIe. This proctoscopic attachment has proved
FIG.
2.
The foot end is lowered and the patient’s and elbows rest on the platform.
head
highIy satisfactory as we11 as economica to us at the University HospitaI and in severaI of the private institutions. The matter of strain on the tabIe has been carefuIIy discussed with manufacturers and the equipment has been endorsed. CONCLUSIONS I. A proctoscopic attachment for a genera1 operating room tabIe which wiI1 permit the patient to assume an inverted position had been presented. 2. By using such an attachment, expenditure for a specia1 proctoscopic tabIe is avoided and no additiona space is needed. 3. This attachment has proved satisfactory and economical.
Professor of Surgery, University OMAHA,
A
LTHOUGH the knee-shotrIder position is adequate for routine proctoscopy, it not infrequently proves awkward for both the patient and the doctor when the examination or operative procedure is proIonged. Even in this position, the end of the proctoscope near the examiner’s eye wiII occasionahy be Iower than the end within the bowe1, so that any retained enema soIution or Iiquid secretion may run into the instrument and prove most annoying. For the weak, elderIy or incapacitated patient and in operative work through the proctoscope, as obtaining a biopsy or removing a polyp, this position is especially fatiguing for both the patient and surgeon. The Iithotomy and IateraI positions are mentioned only to be condemned. In every instance, the most satisfactory position for proctoscopy is the inverted or Hanes’ position. There are proctoscopic tabIes idea1 for the off&e but as they are designed soIeIy for use in recta1 procedures, their use in hospitaIs wouId require expenditure for a tabIe unsuited for genera1 operative work and a separate room for the table, unless it can be isolated in a corner of one of the operating rooms or the haIlway. This expense and the additiona space required are hardIy warranted. Up to this time, no modification in these tabIes has been presented which wiI1 Ii11the genera1 operating room requirements and stiI1 be advantageous for proctoscopic and recta1 manipuIations as the various positions required in genera1 operative work have prevented the manufacture of a tabIe with a hip break adaptabIe to the requirements of proctoscopy. With these factors in mind, I have designed an attachment for an
F.A.C.S.
of Nebraska
I\IedicaI ColIege
NEBRASKA
operating tabIe which in no way interferes with its general demands, and yet permits the patient to be placed in the inverted position for recta1 procedures. This attachment shouId be used on tabIes which have a hydra&c pump control on the foot leaf. Since a11 genera1 operating tables are constructed with no break at the angIe of the hip, the patient must be turned so that his head is toward the foot of the tabIe. This brings the knee break at the correct pIace for the hip ffexure and by Iowering the foot Ieaf the patient can be pIaced in an inverted position. The referred attachment consists of a sheet of heavy meta molded to a right angIe and attached to a pair of horizontal bars fitted with grips which fasten to the heavy side raiIs at the foot end of the operating tabIe. The vertica1 portion of this meta sheet measures 13 inches in height and serves as the platform on which the head and eIbows rest when the patient’s body is flexed. The 7 inch horizontal meta sheet serves as a support for the horizonta1 bars. These heavy bars are 14 inches Iong and extend onto the vertica1 meta sheet for reinforcement. Bars of Iighter metal angIe across from the platform to the heavy horizontal bars for further support. There must be no cross bar support for a space of 7 inches between the horizonta1 bars at the tabIe attachment end to aIIow for cIearing the foot of the tabIe and for adjustment according to the height of the patient. After the attachment is secured to the foot of the operating tabIe, a foIded bIanket is Iaid on the vertica1 pIatform and on this one or two pihows are pIaced. The usua1 table pad is used. The patient’s head and eIbows rest against the piIIows and the
382
American Journal of Surgery
Best-Proctoscopic
hands grasp the edge of the platform which has been protected by the bIanket. By means of the hydrauhc pump, the Ieg sec-
FIG. I. The apparatus
is attached to the foot end of the table.
tion of the tabIe is graduaIIy dropped and the patient’s head gentIy lowered until he is in the inverted position. Since it is possibIe for the leg section of the tabIe to descend too rapidIy, it shouId always be supported to assure its Iowering sIowIy. With the ScanIan-BaIfour operating tabIe, a fitting with check can be supplied which wiI1 prevent the too rapid Iowering of the Ieg section of the tabIe. After compIetion of the proctoscopic examination, the end of the tabIe is eIevated by means of the pump. If the examination is to be foIIowed by any type of operative procedure in the prone, lithotomy or side position, the attachment is removed and the tabIe pad and patient are rotated on the centra1 axis of the table
Attachment
MAY. 1936
unti1 the patient’s head is at the usual’head of the tabIe. This proctoscopic attachment has proved
FIG.
2.
The foot end is lowered and the patient’s and elbows rest on the platform.
head
highIy satisfactory as we11 as economica to us at the University HospitaI and in severaI of the private institutions. The matter of strain on the tabIe has been carefuIIy discussed with manufacturers and the equipment has been endorsed. CONCLUSIONS I. A proctoscopic attachment for a genera1 operating room tabIe which wiI1 permit the patient to assume an inverted position had been presented. 2. By using such an attachment, expenditure for a specia1 proctoscopic tabIe is avoided and no additiona space is needed. 3. This attachment has proved satisfactory and economical.